Giliberti Paolo, Giordano Lucia, Chello Giovanni, De Leonibus Chiara, Giliberti Paola
Neonatal Intensive Care Unit, Monaldi Hospital, via L. Bianchi, Localita', Naples, Italy.
J Matern Fetal Neonatal Med. 2010 Oct;23 Suppl 3:27-9. doi: 10.3109/14767058.2010.502017.
Shock defines a complex dysfunction of organ perfusion, that produces a status of cellular energy failure, resulting from an insufficient supply of oxygen and nutrients to tissues. The diagnosis of shock is very difficult because of the lack of sufficiently sensitive and specific clinical criteria, and is substantially based on the demonstration of an arterial hypotension, an indicator unfit to detect the organ hypoperfusion. It determines the necessity of firmly introducing in the diagnostic run the functional echocardiography, the near infrared spectroscopy and the amplitude – integrated electroencephalography, etc., in the monitoring of the critical newborn. In order to simplify the problem, the authors identify the clinical scenarios of the newborn's shock to enhance the different pathogenetic moments and to build up appropriate therapeutic algorithms, without forgetting that at present there is no evidence that treatment of shock improves outcomes, despite the large amount of the studies conducted on this topic.
休克定义为器官灌注的复杂功能障碍，它会导致细胞能量衰竭状态，这是由于组织的氧气和营养供应不足所致。由于缺乏足够敏感和特异的临床标准，休克的诊断非常困难，并且基本上基于动脉低血压的表现，而这一指标并不适合检测器官灌注不足。这就决定了在对危重新生儿的监测中，必须在诊断过程中坚定地引入功能超声心动图、近红外光谱和振幅整合脑电图等检查。为了简化问题，作者确定了新生儿休克的临床情况，以强化不同的发病阶段，并建立适当的治疗算法，同时不要忘记，尽管针对该主题进行了大量研究，但目前尚无证据表明休克治疗能改善预后。
