Early recognition and prevention of perioperative patients with shock        SHI Yan，WENG Li，DU Bin. Peking Union Medical College Hospital，Beijing 100032，China
Corresponding author：DU Bin，E-mail：dubin98@gmail.com
Abstract    Shock is the clinical syndrome of circulatory failure that results in tissue hypoperfusion and inadequate cellular oxygen utilization. Shock is associated with high morbidity and mortality in patients during perioperative period. Early recognition and prevention are crucial to prevent organ dysfunction and/or failure as well as to improve clinical outcome. Systemic arterial hypotension，as a conventional parameter，often becomes evident until decompensation phase of shock. A large body of evidence suggested that tissue hypoperfusion based on clinical evaluation，hemodynamic profile，and biochemical tests (e.g. hyperlactatemia) may help early identification of compensatory shock. Clinical signs have been shown to be an early marker of inadequate tissue perfusion，which are apparent through the three“windows”：neurologic (altered mental state，which typically includes obtundation，disorientation and confusion)，renal and cutaneous (skin that is cold and clammy，cyanosis). Despite the lack of evidence-based effective measures，a multifacet strategy including recognition of high-risk patients，better preoperative preparation and appropriate perioperative management remains the cornerstone of shock prevention.