→ ineihs:你的解釋深得我心^^ 08/03 12:06
推 donglink:推~ 08/03 12:07
→ ineihs:原po我愛你\^o^/ 08/03 12:08
推 ikwu:推 我也是選D... 08/03 12:14
補充一點資料
題目上所說的Refractory shock 在這篇資料上是指說
"即使給予了適當與足夠的治療 休克情況仍然繼續''
我是選d 但我覺得所有答案都會造成Refractory shock
因為B的選項是說'血液容積持續不足'
假使病人持續被輸血
但體內有無法修復的血管破裂(或血管瘤破裂)
抑或是嚴重外傷 輸在多的血也是血流入體腔
沒辦法抵達主要器官
這樣即使輸血也無法提升'血液容積' 也應會造成Refractory shock
希望選項通通OK^^
資料來源
http://0rz.tw/NQBO6
The terms refractory shock and irreversible shock are widely used by
physicians and other medical workers to refer to types of shock that present
particularly difficult problems. The term refractory shock is applied when,
in spite of apparently adequate therapy, the shock state continues. Commonly,
the treatment later proves to have been inadequate, in which case the shock
was not true refractory shock. This often occurs following a major injury in
which there is internal bleeding, leading to underestimation of true blood
loss and therefore to inadequate transfusion. In certain cases, however, even
if the therapy actually is appropriate, the shock state persists; if patients
in such cases respond to further special treatment, then this is true
physiological refractory shock.
In severe or prolonged shock states, the myocardial blood supply is
sufficiently diminished to damage the heart’s pumping action temporarily or
permanently. Also, noxious products of inadequately perfused tissues may
circulate and affect the heart muscle.
While the flow of blood through major vessels is under the control of the
nerves, circulation through the capillary beds is of a more primitive type
and is under the influence of local metabolic products. In shock, arteriolar
constriction causes inadequate flow through the tissues, and local waste
products increase. These cause dilation of the capillary sphincters and
opening of the whole capillary bed, which thus contains an increased
proportion of the blood volume. The capillaries become further engorged with
slowly flowing blood, and fluid leaks through the vessel walls into the
tissues. Thus, the body is further deprived of circulating blood volume.
Widespread clotting of the blood can occur during capillary stagnation. This
leads to severe damage to the cells unsupplied by flowing blood. Later, when
enzymes dissolve the fibrin of the clots, the flow through these areas
carries toxic metabolic products to vital organs—such as the heart, kidneys,
or liver—and the ensuing damage leads to irreversibility of shock.
※ 引述《eel (小鰻)》之銘言：
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: 請大家發文時多花點時間寫囉。 (此兩行字可自行按crtl+y刪掉)
: 題號: 醫學(__) 第___題
: 題目內容:
: 下列何者不是refractory shock or irreversible shock 的原因?
: 題目疑義:
: 答案給B 血液容積持續不足????
: 如果我沒錯的話..shock的定義不就是血液灌流不足嘛??
: 反而是shock跟答案D的 ARDS有什麼關係了...
: 本題建議處理方式:
: B改D
: 參考來源:
※ 編輯: vincialove 來自: 112.78.73.59 (08/03 12:06)