1、腹 部 損 傷 Abdominal Trauma,上海交通大學醫(yī)學院外科學教研室 上海交通大學醫(yī)學院附屬瑞金醫(yī)院普外科,About myself,Name: 費 健 Email: feijian Mobile:137-0176-9798,開始了 大家要專心啊,一個例子 四大問題,A 22 year old man was driving drunk and without his seatbelt fastened when he was involved in a single-vehicle automobile accident. When attended by EMT（abbr. e

2、mergency medical technician 急診醫(yī)士） personnel, no information was available about the time of the accident. He was found agitated and complaining of abdominal pain.,Study Questions 1: Whats your first impression of this case?,Open or Closed Injuries ? Hollow or Solid Organs ? Single or Multiple ?,病史詢問

3、 病患受傷之可能機轉(zhuǎn)，如車禍之車體損傷嚴重度，是否用安全帶，救援病患之時間從病患或家屬快速取得AMPLE資料，但不可因為問病史而耽誤急救處置。,病史詢問 A : Allergy 過敏史 M : Medication 用藥史 P : Past history 過去病史 L : Last meal 最后一次進食喝水時間及 LMP ( 女性 ) E : Event 外傷發(fā)生之經(jīng)過史,Study Questions 2: Whats the key points of physical exam?,His airway was patent. At the scene, he was breathin

4、g at 20 per minute with a blood pressure of 90/60 and a pulse of 130. He was placed in a hard cervical collar and on a back board and transported to your emergency room. Upon arrival his vital signs are the same, with a temperature of 36oC.,His abdomen is markedly distended. His hands and feet are c

5、old, his legs mottled.,理學檢查 病患是否有休克癥狀 ( tachycardiatachypneacold swealing ) 胸腹部是否有開放性傷口 胸腹部是否有挫傷瘀血腫等 女性病患應注意是否懷孕,Study Questions 3: What will you do next?,-A nasogastric tube reveals green liquid. -A urinary catheter reveals dark yellow urine. -His hemoglobin is 7. -His abdominal lavage（灌洗）reveals g

6、ross blood.,診斷工具 Laboratory Data Hb,Hct ( serial measurement ) Base line WBC Coagulation studies Baseline electrolyte Liver and renal function tests Serum amylase Urinalysis,Study Questions 4: Whats the final diagnosis?,影像學檢查： X線平片、CT、 B超、DSA,目的要求：,了解：腹部損傷的分類、病因和病理； 掌握：腹部損傷的臨床表現(xiàn)； 熟練掌握：腹部閉合性損傷引起的臟器破裂

7、、出血、穿孔的診斷及治療原則。,思考題,腹部閉合性損傷的診斷 腹腔診斷性穿刺的方法及意義 脾破裂的治療方法,New Eng J Med Volume 356:1353-1360 March 29, 2007 Number 13 NextCase 10-2007 A 55-Year-Old Man Impaled in a Rowing Accident,男30歲，由5m高處跌下2小時。腹痛，腹肌緊張，有壓痛和反跳痛，腸鳴音弱。血壓104/70mmHg，脈率120次/分，血紅蛋白80g/L。X線檢查：右側(cè)第9、10肋骨骨折，右側(cè)膈肌升高。最可能的診斷是（ ）。 A肝破裂 B胃破裂 C脾破裂 D橫結(jié)腸破裂 E胰腺斷裂,腹部閉合傷，確診有無內(nèi)臟傷最簡便，最可靠的診斷方法為（ ）。 AX線照片 BCT C白細胞計數(shù) DB超 E腹腔穿刺。,腹部閉合性損傷，以下都是不能早期確診的原因除了（ ）。 A實質(zhì)臟器損傷但其被膜未破 B同時合并其他部位的嚴重損傷 C空腔臟器穿孔不大 D腹腔穿刺抽出不凝固血液 E后腹膜臟器的損傷,A腹膜炎出現(xiàn)