Last lesson , we have studied the features

and the mechanism of microcirculatory

ischemic hypoxia during shock .

Now continue :
 3. The Effects of Microcirculatory
Ischemic Hypoxia

1) Compensation :

①restoring return heart blood volume (by aut-

blood-transfusion and aut-fluid- transfusion etc.).
 venule
A-V
true capillary shunt

Precapillary arteriole
sphincter

postarteriole
后微动脉

Aut-blood-transfusion is caused by vein constriction

and arteriole – venule shunts opening.
Aut-fluid- transfusion is caused by capillary pressure↓.
② Redistribution of blood flow
( normal of the brain and heart blood
flow ,but other organs blood flow↓) .

③ heart function ↑.

④ maintain arterial blood pressure .

2) Main Clinical Manifestations
and Mechanism

( Mechanism——Why occur they ? )

 Mechanism
Activation of sympathetic adrenal
medulla system

noradrenaline and
adrenaline ↑

Vasoconstriction of Central
rate of heart ↑ kidney and skin↑ sweat gland nerve
myocardial secretion system
excitation
contractility ↑ ↑
Peripheral resistance
Skin
↑ Renal
Ischemia Ischemia
dysphoria

BP(–) oliguria sweat↑

Pale face
pulse pressure ↓ extremities
rapid pulse cold Clinical
manifestation
 ( 二 ) Stagnant hypoxia Stage

1 the features of microcirculatory changes

 venule
A-V
true capillary shunt

Precapillary
sphincter arteriole

后微动脉
postarteriole

features ：
 Precapillary resistance(vasodilation) less than
postcapillary resistance (vasoconstriction)
 opening capillary↑
 more perfusion and less flow
2. The Mechanism of Microcirculatory Stasis
hydrogen ion↑
Precapillary resistance(vasodilation) <
Histamine↑
postcapillary resistance (vasoconstriction)
Kinin ↑
and so on Blood stagnation

Fluid ooze↑

Venous return↓
↑
cardiac output↓↓

Hypotension hypoxia
3.The Effects of Microcirculatory
Stasis
1)Decompensation:
① Return heart blood volume↓( Aut-blood-transfusion

and aut-fluid-transfusion stop.)

②The brain and heart blood flow↓
③Heart function ↓.
④Arterial blood pressure ↓.

2) Main Clinical Manifestations and

Mechanism
 Microcirculatory
Stasis

Peripheral
resistance↓ Return heart blood
volume ↓

BP↓ Cardiac output↓

Brain renal blood flow↓ renal blood Skin blood

ischemia stasis stasis

Apathy Oliguria or anuria cyanotic

 ( 三 ) Stage of microcirculatory Failure
(stage of Disseminated Intravascular Coagulation)

1 the features of microcirculatory changes ：

 venule
true capillary A-V
shunt

Precapillary
sphincter arteriole

后微动脉
postarteriole

features ：
 Microcirculatory vessele paralysis dilation
 Microthrombosis

 no perfusion and no flow

2. The Mechanism of Microthrombosis
(The Mechanism of disseminated
intravascular coagulation ）

（ 1 ） blood concentrate ， viscosity ，

blood cells aggregation
（ 2 ） Damage of vascular endothelial cells
activate intrinsic pathway.
（ 3 ） Tissue injury activate extrinsic pathway.
and so on.
3. Main Clinical Manifestations of
Microcirculatory Failure Stage
1 ). BP obvious ↓
2 ). Bleeding
3 ) . Multiple Organs Dysfunction (MOD)

Clinical Manifestations of disseminated

intravascular coagulation
四、 General Effects of Shock

( 一 ) 、 Disorder of Cellular Metabolism

Adenosine
triphosphate Sodium Cell edema
(ATP ) pump hyperkalemia
Ischemia
hypoxia Lactic
acid acidosis
（二）、 Multiple Organic
Disfunction
 1. Renal Failure

Early stage glomerular

filtration
rate
Renal （ GFR ）
perfusion↓ ↓ oliguria

Acute functional renal failure

 Stage of shock and
late stage

continuance renal Acute renal Oliguria

ischemia and tubular necrosis or anuria
microthrombosis

Acute parenchymal renal failure

 2. Lung Disfunction

Concept of shock lung : Acute respiratory

Failure occur during shock .

the shock lung = acute respiratory distress

syndrome (ARDS)
The possible mechanisms of the shock lung :
1. Pulmonary vasoconstricton.
2. Decrease in alveolar surfactant.
3. Formation of alveolar hyaline membrane.
4. DIC in lungs.

Main Clinical Manifestations of shock lung

are:
1. progressive dyspnea
2. reduced arterial oxygen tension
3. cyanosis
 3.Cardiac disfunction
in early stage, cardiac function ↑.

In the other stages, acute cardiac failure may occur.

mechanisms :

(1) Hypotension → coronary arterial blood flow↓.

(2) Acidosis and hyperkalemia.

(3) DIC in myocardium.
(4) Production of myocardial depressant factor (MDF).
(5) Effects of endotoxin.
4. Disfunction of Digestive System
intestinal tract

Ischemia
Barrier function Endotoxin enter blood
Stasis

endotoxemia
hepatic detoxification↓
 5. The Changs of Brain Function

Manifestations of the brain disfunction at different

stages of shock:

Excitation → (Stage of shock )

(Early stage of shock )
inhibite → (Late stage of shock ) coma.
 五、 Principles of shock treatment
The aim of treatment of shock is to restore
the adequate microcirculatory perfusion.
1. Treatment of the shock causes.
2. Restoring blood volume: Rapid enough supply
fluid(N. S, dextran, etc.) or blood.
3. Adjustment of disturbed vascular resistance :
early stage — using vasodilation drugs
shock stage and anaphylactic shock — using
vasoconstriction drugs
etc.
4. Restoring heart function ： using isoprenaline,
digitalis etc.
5. Correcting disturbances of acid-base ： using
sodium bicarbonate
6. Supporting the function of the vital organs
and improving function of cells (using ATP, etc).
THANK YOU！ 再见！