Savremeni koncept etiopatogeneze i dijagnostike šoka
Modern concept of shock
Sažetak
Uvod: Šok predstavlja životno ugrožavajuće stanje koje se javlja zbog neusklađenosti ponude i potrošnje kiseonika što dovodi do ćelijske i tkivne hipoksije, pa nastaje ćelijska smrt i disfunkcija vitalnih organa. Efekti šoka su reverzibilni u ranim fazama, ali odlaganje dijagnoze i započinjanja lečenja može dovesti do nepovratnih promena, uključujući multiorgansku insuficijenciju (MODS) i smrt. Postoje četiri glavne kategorije šoka: hipovolemijski, distributivni, kardiogeni i opstruktivni.
Etiologija: Hipovolemijski šok može nastati usled hemoragičnih i nehemoragičnih uzroka. Distributivni šok se deli na septički, sindrom sistemskog inflamatornog odgovora (SIRS), anafilaktički, neurogeni i endokrini usled razlika u njihovoj etiopatogenezi. Kardiogeni šok nastaje usled intrakardijalnih uzroka, dok se opstruktivni šok javlja usled ekstrakardijalnih faktora.
Patogeneza: Patogeneza svakog podtipa šoka je različita u zavisnosti od načina nastanka. Uopšteno govoreći šok ima tri faze: kompenzovanu, fazu celularnog distresa i dekompenzovanu. Kada šok pređe u ireverzibilnu fazu dolazi do multiorganskog oštećenja (MODS) i smrti.
Klinička slika: Simptomi mogu varirati u zavisnosti od vrste i stadijuma šoka. Najvažnije promene koje se dešavaju tokom ovog sindroma su na nivou hemodinamike, pa su i najčešći klinički znaci koji upućuju na šok hipotenzija, tahikardija, tahipneja, poremećen mentalni status, hladni ekstremiteti, modra koža i oligurija.
Dijagnoza: Dijagnoza šoka se zasniva na anamnezi, kliničkoj slici, fizikalnom pregledu, vitalnim parametrima i biohemijskim analizama. Veliku ulogu u postavljanju dijagnoze imaju i SOFA kriterijumi (skor procene sekvencijalnog otkazivanja organa), SIRS kriterijumi, acidobazni status, krvna slika, hemodinamski monitoring, merenje diureze, rentgen grudnog koša, hemokultura i drugo.
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