肠梗阻 外科相关护理学课件.ppt

张某，男性，48岁 阵发性腹痛、恶心、呕吐 、 停止排便、排气三天。 2年前曾行阑尾切除术。 入院检查：T37.8℃ P110次/分 BP16/11Kpa 呈急性病容，神志清 ;腹部膨隆见肠型及蠕动波，肠鸣音亢进有气过水声，腹部压痛明显，以右侧腹为重，有轻度腹肌紧张及反跳痛，叩诊为鼓音。 X线：肠胀气，肠管增粗并有液平面。 血液检查 ：WBC 13×109/L N 92% Na+ 120mmol/L K+ 3.0mmol/L 血糖10.5mmol/L;肠梗阻 Intestinal obstraction; Whenever gastrointestinal luminal content is pathologically prevented from passing distally ;1. According to its Basic causes 2. Vascular supply to intestinal wall 3. Obstruction level or site 4. The extent of obstruction 5. Progression of obstruction ;mechanical obstruction; Dynamic obstruction;Obstruction of vascular supply origin;1. 按梗阻发生的原因 2. 按肠壁有无血运障碍 单纯性肠梗阻 (Simple obstruction) 绞窄性肠梗阻 (Strangulation obstruction) ;1. According to its Basic causes 2. Vascular supply to intestinal wall 3. 按梗阻发生的部位 高位肠梗阻(high obstruction ) 低位肠梗阻(low obstruction);1. According to its Basic causes 2. Vascular supply to intestinal wall 3. Obstruction level or site 4. 按梗阻发生的程度 完全性肠梗阻(complete obstruction) 不完全性肠梗阻(Incomplete obstruction);1. According to its Basic causes 2. Vascular supply to intestinal wall 3. Obstruction level or site 4. The extent of obstruction 5. 按梗阻发生的速度 急性肠梗阻(Acute obstruction) 慢性肠梗阻(chronic obstruction);Pathophysiology;Simple mechanical obstruction 梗阻以上肠蠕动增多(contracts vigorously) 梗阻以上肠管膨胀(distention) 梗阻以下肠管瘪陷 膨胀和瘪陷交界处为梗阻所在;Acute complete obstruction 　　　肠腔压力↑→静脉回流受阻→肠壁水肿、增厚、呈暗红色→动脉血运受阻→肠管变成紫黑色→坏死、穿孔。;Chronic incomplete obstruction 梗阻以上肠腔扩张、肠壁代偿性肥厚 腹壁视诊常可见扩大的肠型和肠蠕动坡。;全身性病理生理改变 主要由于体液丧失、肠膨胀、毒素的吸收和感染所致;体液丧失(lose of body fluid) 引起水、电解质紊乱与酸碱失衡 全身性感染和毒血症 腹膜炎和中毒(peritonitis and poisoning) shock respiration and circulation disorder);Clinical Manifestations;痛;Clinical Manifestations;痛;痛;痛;How to observe distention？ 腹部膨隆 腹壁紧张、皮肤发亮 呼吸困难、不能平卧 X线检查 血气;机理;痛; Clinical Manifestations; ;Hemic vomitus,drainage Conservative treatment in vain and no improvement in symptoms and signs X线检查符合绞窄性肠梗阻特点;鱼骨刺状;accessory examination ;1. 化 验 检 查 血红蛋白值↑ 血细胞比容↑ 尿化重↑ 白细胞、中性粒细胞↑ 粪便、血气分析血电解质、尿素