夜大腸梗阻課件護(hù)理十治療原則TREATMENT基礎(chǔ)治療禁食水胃腸減壓糾正水電酸堿失衡控制感染其他解除梗阻非手術(shù)治療單純性腸梗阻手術(shù)治療絞窄或?qū)⒁g窄1去除原因2切除吻合3短路手術(shù)4腸造口或腸外置十一護(hù)理方案及其進(jìn)展目標(biāo)減輕緩解穩(wěn)定改善預(yù)防臨床基本護(hù)理術(shù)前護(hù)理術(shù)后護(hù)理專業(yè)特色護(hù)理術(shù)后早期炎性腸梗阻1臨床癥狀體征檢查癥狀的特殊性體征觸診柔韌的實(shí)性感X線積液明顯2診斷標(biāo)準(zhǔn)近期手術(shù)史吐脹閉體檢X線排除其他3治療預(yù)防禁食水胃腸減壓生長(zhǎng)抑素腎上腺皮質(zhì)激素腸外營(yíng)養(yǎng)抗炎腸內(nèi)營(yíng)養(yǎng)中醫(yī)中藥預(yù)防觀察與護(hù)理體位與活動(dòng)腹部觀察胃腸減壓護(hù)理給要觀察腸外營(yíng)養(yǎng)護(hù)理物理療法的護(hù)理判斷手術(shù)指征心理疏導(dǎo)健康指導(dǎo)謝謝3根據(jù)腸梗阻部位分為高位腸梗阻HIGHINTESTINALOBSTRUCTION低位腸梗阻LOWINTESTINALOBSTRUCTION相對(duì)概念4根據(jù)發(fā)病過(guò)程分為急性完全性腸梗阻COMPLETEINTESTINALOBSTRUCTION慢性不完全性腸梗阻PARTIALINTESTINALOBSTRUCTION四病理PATHOLOGY1動(dòng)力性腸梗阻病理改變麻痹性PARALYTIC腸痙攣SPASTIC2血運(yùn)性腸梗阻病理改變?nèi)毖狪SCHEMIA壞死NECROSIS3機(jī)械性腸梗阻病理改變慢性不全性腸梗阻病理改變急性完全性腸梗阻病理改變五病理生理PATHOPHYSIOLOGY1體液丟失不能進(jìn)食嘔吐VOMITING腸腔積液三間隙積液靜脈回流VENOUSRETURN受阻少尿OLIGURIA代謝性酸中毒METABOLICACIDOSIS2感染中毒菌血癥BACTEREMIA敗血癥SEPTEMIA毒血癥TOXEMIA3呼吸循環(huán)影響休克肺ARDS腹壓ABDOMINALPRESSURE增高回心血量減少腹式呼吸減弱六臨床表現(xiàn)CLINICALFINDINGS1癥狀1痛ABDOMINALPAIN特點(diǎn)機(jī)械性血運(yùn)性動(dòng)力性2嘔VOMITING反射性溢出性早遲有無(wú)3脹ABDOMINALDISTENSION早遲有無(wú)與部位相關(guān)對(duì)稱性不對(duì)稱性周圍型中央型4閉APOLIPSIS完全停止排氣排便早期可有少量排氣排便血性粘液便絞窄套疊六臨床表現(xiàn)CLINICALFINDINGS2COMPLETEPROXIMALOBSTRUCTIONVOMITINGABDOMINALDISCOMFORTORALCONTRASTXRAYSVOMITINGCOMPLETEMIDORDISTALOBSTRUCTIONCOLICKYABDOMINALPAINVOMITINGABDOMINALDISTENTIONCONSTIPATIONOBSTIPATIONPERISTALTICRUSHESDILATEDSMALLBOWELONXRAYCRAMPINGPAIN七體征SIGNS1望INSPECTION一般情況體位表情腹部情況2觸PALPATION壓痛痛性包塊條索狀包塊腹膜刺激3叩PERCUSSION鼓音移動(dòng)性濁音4聽AUSCULTATION腸鳴音亢進(jìn)氣過(guò)水音金屬音腸鳴音減弱消失5直腸指檢RECTALTOUCH腫瘤套疊頭血性粘液便八輔助檢查1LABFINDINGSEARLYMAYBENORMALIMAGINGSTUDIESSUPINEANDUPRIGHTPLAINABDOMINALFILMSLADDERLIKEPATTERNOFDILATEDSMALLBOWLLOOPSWITHAIRFLUIDLEVELSIMAGINGSTUDIESEARLYOBSTRUCTION36HPROXIMALOBSTRUCTIONCLOSEDLOOPOBSTRUCTIONFLUIDFILLEDLOOPSCONTAINLITTLEGAS八輔助檢查2IMAGINGSTUDIESCOLONISOFTENDEVOIDOFGASEXCEPTENEMAORPARTIALOBSTRUCTIONIMAGINGSTUDIESIFTHEPATIENTHASAHISTORYOFABDOMINALMALIGNANCYCTSCAN九診斷要點(diǎn)DIAGNOSES1確定是否腸梗阻2機(jī)械性動(dòng)力性血運(yùn)性3單純性絞窄性壞死性4完全與否5部位高低6具體病因7輔助檢查腸梗阻夜大腸梗阻課件護(hù)理一概念腸內(nèi)容物不能順利通過(guò)腸腔外科學(xué)的急腹癥56MFORADULTFROMLIGAMENTOFTREITZTOTHEILEOCECALVALVE25JEJUNUM35ILEUM二病因?qū)WETIOLOGY病因和分類有多種分類三腸梗阻分類1按腸梗阻病因發(fā)病機(jī)理分為機(jī)械性腸梗阻MECHANICALINTESTINALOBSTRUCTION動(dòng)力性腸梗阻DYNAMICINTESTINALOBSTRUCTION血運(yùn)性腸梗阻VASCULARINTESTINALOBSTRUCTION機(jī)械性MECHANICAL腸腔堵塞寄生蟲糞塊異物等腸管受壓如腸管扭轉(zhuǎn)嵌頓疝或受腫瘤壓迫等腸壁病變?nèi)缦忍煨阅c道閉鎖炎癥性狹窄腫瘤等引起動(dòng)力性DYNAMIC麻痹性PARALYTIC如急性彌漫性腹膜炎腹部大手術(shù)腹膜后血腫等引起痙攣性SPASTIC如鉛中毒血運(yùn)性VASCULAR由于腸系膜血管栓塞或血栓形成引起多見于老年人2按腸梗阻病理階段分