消化道大出血的診斷與外科處理原則課件

消化道大出血的診斷與外科處理原則ppt課件匯報(bào)人：文小庫(kù)2024-03-15CONTENTS消化道大出血概述診斷方法與技巧外科處理原則及適應(yīng)證并發(fā)癥預(yù)防與處理策略康復(fù)期管理與生活調(diào)整建議總結(jié)回顧與展望未來(lái)進(jìn)展方向消化道大出血概述01定義消化道大出血是指消化道內(nèi)出血量達(dá)到一定程度，引起明顯臨床癥狀的嚴(yán)重病癥。分類(lèi)根據(jù)出血部位不同，可分為上消化道大出血和下消化道大出血。上消化道大出血包括食管、胃、十二指腸以及胰腺、膽道等部位的出血；下消化道大出血?jiǎng)t包括空腸以下至直腸的出血。定義與分類(lèi)消化道大出血的常見(jiàn)原因包括消化性潰瘍、食管胃底靜脈曲張破裂、急性出血性胃炎、糜爛性胃炎、胃癌、腸道腫瘤等。發(fā)病原因長(zhǎng)期飲食不規(guī)律、過(guò)度飲酒、吸煙、服用非甾體類(lèi)抗炎藥等均可增加消化道大出血的風(fēng)險(xiǎn)。危險(xiǎn)因素發(fā)病原因及危險(xiǎn)因素以下附贈(zèng)各項(xiàng)管理制度英文版（不需要可刪）急救藥品、器材管理制度:1.Rescuedrugsandequipmentshouldbe"fivefixed"(fixedquantityandvariety,designatedplacement,designatedpersonstorage,regulardisinfectionandsterilization,regularinspectionandmaintenance)and"twotimely"(timelyinspectionandmaintenance,timelyreceiptandsupplementation).Theitemisclearlymarkedandcannotbeusedarbitrarily.2.Thenecessaryrescueequipmentiscomplete,ingoodperformance,andinstandbycondition.3.Therescuedrugsarecomplete,withcleardruglabelsandnodiscoloration,deterioration,expiration,ordamage.Theyshouldbeplacedandusedintheorderofdrugexpirationdates(fromrighttoleft).4.Emergencydrugsanditemsforeachdepartment'srescuevehicleshallbeuniformlyequippedaccordingtorequirements.Specializedemergencydrugsanditemsmustbereviewedandapprovedbythedepartmentdirectortodeterminethetype,quantity,specifications,anddosagetobeequipped.Rescuevehiclesmustbeplacedindesignatedlocationsandmanagedbydesignatedpersonneltoensuresafetyandeaseofuse.5.Afterusingrescuedrugsandequipment,theyshouldbefullyreplenishedwithin24hours.Iftheycannotbereplenishedduetospecialreasons,theyshouldbenotedonthehandoverregistrationformandreportedtotheheadnurseforcoordinationandresolutiontoensuretimelyuseduringpatientrescue.6.Thereisaregistrationbookfortheprovisionofdrugsandequipment.Ensureconsistencybetweenaccountsandmaterials,andhandoverbetweenshifts.7.Managementofsealedrescuevehicles:Beforesealing,theheadnurse(ornurseincharge)andanothernurseshallcountthedrugsandequipmentaccordingtotheregistrationbookofdrugandequipmentequipment,verifytheiraccuracy,andsealthemwithaseal.Twopeopleshallsignandfillinthesealingtime.Nurseschecktheconditionofthesealsoncepershiftandcompletethehandover.Theresponsiblenursescheckonceaweek,andtheheadnurseandresponsiblenursesopenthesealsandinspectthedrugsandequipmentintheambulanceonceamonth,withrecordskept.8.Nonsealedrescuevehiclemanagement:Eachshiftshallcountthedrugsandequipmentaccordingtotheregistrationbookandcompletethehandover.Theresponsiblenurseshallinspectonceaweek,andtheheadnurseshallinspectonceeverytwoweeksandkeeprecords,ensuringthattheaccountsmatchthematerials.護(hù)理文書(shū)書(shū)寫(xiě)制度:

1.Nursingstaffstrictlyfollowthelatestrequirementswhenwritingnursingmedicalrecords.2.Thecontentofnursingrecordsshouldbeobjective,truthful,accurate,timely,complete,andstandardized.3.Allnursingdocumentsshouldbewrittenwithablueblackorcarboninkpen.4.AllnursingdocumentsshouldbewritteninArabicnumeralsfordateandtime,withdatesinyears,months,anddays,usinga24-hoursystem,specifictominutes.5.WritingshoulduseChinese,medicalterminology,andcommonlyusedforeignlanguageabbreviations;Completerecorditems;Thetextisneat,thehandwritingisclear,andthelayoutisclean;Accurateexpression,fluentsentences,simpleandconcise:correctformatandpunctuation,notypos.6.Whenerrorsoccurduringthewritingprocess,doublelinethemonthewrongwords,keeptheoriginalrecordclearanddistinguishable,signthemodifier,indicatethemodificationtime,continuetowritethecorrectcontent,anddonotusescraping,sticking,paintingorothermethodstocoveruporremovetheoriginalhandwriting.Eachpageshouldbemodifiednomorethantwotimes,otherwisetheoriginalrecorderwillpromptlycopyagain(exceptformodificationsmadebysuperiors).7.Nursingrecordswrittenbyinternnurses,probationarynurses,orunregisterednursesshouldbereviewedandsignedbynurseswithlegalprofessionalqualificationsinthismedicalinstitution.8.Furthertrainingnursescanonlywritenursingdocumentsafterbeingrecognizedbythemedicalinstitutionreceivingthetrainingfortheirworkability.9.Superiornursingstaffhavetheresponsibilitytoreviewandmodifythewrittenrecordsofsubordinatenursingstaff.Whenmakingmodifications,reddoublelinesshouldbeusedtomarkerrors,writethemodifiedcontent,signandindicatethemodificationtime.10.Temperaturerecords,medicalorders,patientcarerecords,andsurgicalinventoryrecordsshouldbearchivedontime.臨床表現(xiàn)消化道大出血的主要臨床表現(xiàn)包括嘔血、黑便、便血等，同時(shí)伴有頭暈、乏力、心悸、出汗等血容量不足的癥狀。嚴(yán)重者可出現(xiàn)休克、昏迷等危及生命的表現(xiàn)。診斷依據(jù)根據(jù)患者的臨床癥狀、體征以及實(shí)驗(yàn)室檢查結(jié)果，如血常規(guī)、便常規(guī)、凝血功能等，結(jié)合內(nèi)鏡檢查、影像學(xué)檢查等手段，可對(duì)消化道大出血做出明確診斷。臨床表現(xiàn)與診斷依據(jù)診斷方法與技巧02詳細(xì)詢(xún)問(wèn)患者病史，包括既往病史、用藥史、手術(shù)史等，特別注意與消化道出血相關(guān)的癥狀，如嘔血、黑便等。全面進(jìn)行體格檢查，注意患者生命體征、腹部體征等，評(píng)估患者病情嚴(yán)重程度。病史采集與體格檢查體格檢查重點(diǎn)病史采集要點(diǎn)血常規(guī)、尿常規(guī)、便常規(guī)等，了解患者基礎(chǔ)情況。肝腎功能、電解質(zhì)等，評(píng)估患者內(nèi)環(huán)境穩(wěn)定性。凝血酶原時(shí)間、部分活化凝血活酶時(shí)間等，判斷患者凝血功能狀態(tài)。常規(guī)檢查生化檢查凝血功能檢查實(shí)驗(yàn)室檢查項(xiàng)目選擇及意義腹部平片可顯示胃腸道積氣、積液等間接征象?？娠@示胃腸道壁增厚、腹腔積液等直接征象，有助于判斷出血部位和原因。對(duì)于某些特殊部位如小腸出血，MRI檢查具有較高診斷價(jià)值。X線(xiàn)檢查CT檢查MRI檢查影像學(xué)檢查在診斷中應(yīng)用胃鏡檢查結(jié)腸鏡檢查小腸鏡檢查注意事項(xiàng)內(nèi)鏡檢查技巧和注意事項(xiàng)可直接觀(guān)察食管、胃、十二指腸等上消化道黏膜病變，并可進(jìn)行活檢和治療。對(duì)于小腸出血，小腸鏡檢查是重要診斷手段，但操作難度較大。可觀(guān)察結(jié)直腸黏膜病變，對(duì)于下消化道出血具有重要診斷價(jià)值。內(nèi)鏡檢查前需充分準(zhǔn)備，如禁食、清潔腸道等；檢查過(guò)程中注意觀(guān)察患者生命體征變化，確保安全。外科處理原則及適應(yīng)證03保持患者生命體征穩(wěn)定，進(jìn)行全面評(píng)估以確定出血原因和部位。應(yīng)用止血藥、抑酸藥等，控制出血并預(yù)防并發(fā)癥。對(duì)于藥物治療無(wú)效的患者，可考慮內(nèi)鏡下止血治療，如注射止血、電凝等。對(duì)于嚴(yán)重出血或內(nèi)鏡治療失敗的患者，應(yīng)及時(shí)進(jìn)行手術(shù)治療。初步復(fù)蘇與評(píng)估藥物治療內(nèi)鏡治療手術(shù)治療急性上消化道出血外科處理原則同樣需要保持患者生命體征穩(wěn)定，并進(jìn)行全面評(píng)估。對(duì)于疑似下消化道出血的患者，應(yīng)盡早進(jìn)行結(jié)腸鏡檢查以明確出血原因和部位。應(yīng)用止血藥、抗生素等，控制出血并預(yù)防感染。對(duì)于嚴(yán)重出血或藥物治療無(wú)效的患者，應(yīng)考慮手術(shù)治療，如切除病變腸段等。初步評(píng)估與復(fù)蘇結(jié)腸鏡檢查藥物治療手術(shù)治療下消化道出血外科治療策略應(yīng)更加注意患者的心肺功能，盡量減少手術(shù)創(chuàng)傷和并發(fā)癥。在保障母嬰安全的前提下，選擇合適的治療方案，必要時(shí)可終止妊娠。應(yīng)綜合考慮患者的整體狀況，制定個(gè)性化的治療方案。老年患者孕產(chǎn)婦合并其他疾病的患者特殊情況下的處理方案手術(shù)適應(yīng)證評(píng)估和選擇手術(shù)適應(yīng)證包括嚴(yán)重出血、藥物治療無(wú)效、內(nèi)鏡治療失敗、危及生命等情況。手術(shù)方式選擇根據(jù)患者的具體病情和身體狀況，選擇合適的手術(shù)方式，如開(kāi)腹手術(shù)、腹腔鏡手術(shù)等。同時(shí)，應(yīng)遵循損傷小、恢復(fù)快、并發(fā)癥少等原則。并發(fā)癥預(yù)防與處理策略04血液在消化道內(nèi)積聚，可能引發(fā)嘔吐，嘔吐物誤入呼吸道可導(dǎo)致窒息。01020304大量失血導(dǎo)致循環(huán)血量減少，引發(fā)休克，表現(xiàn)為血壓下降、心率加快、面色蒼白等癥狀。消化道大出血后，腸道細(xì)菌易位進(jìn)入血液，引發(fā)全身感染。持續(xù)大量失血可導(dǎo)致多器官功能衰竭，危及生命。休克感染窒息多器官功能衰竭常見(jiàn)并發(fā)癥類(lèi)型及危險(xiǎn)因素對(duì)可能導(dǎo)致消化道大出血的疾病進(jìn)行積極治療，如消化性潰瘍、肝硬化等。積極治療原發(fā)病避免誘發(fā)因素加強(qiáng)監(jiān)測(cè)避免過(guò)度勞累、情緒激動(dòng)、飲食不當(dāng)?shù)瓤赡苷T發(fā)消化道大出血的因素。對(duì)高危人群進(jìn)行定期監(jiān)測(cè)，及時(shí)發(fā)現(xiàn)并處理出血風(fēng)險(xiǎn)。030201預(yù)防措施建議止血措施根據(jù)出血原因和部位，采取相應(yīng)的止血措施，如藥物止血、內(nèi)鏡下止血、手術(shù)止血等。加強(qiáng)護(hù)理保持患者呼吸道通暢，避免嘔吐物誤入呼吸道；保持皮膚清潔干燥，預(yù)防壓瘡等護(hù)理并發(fā)癥。防治并發(fā)癥密切監(jiān)測(cè)患者生命體征，及時(shí)發(fā)現(xiàn)并處理休克、窒息、感染等并發(fā)癥。迅速補(bǔ)充血容量立即建立靜脈通道，輸注晶體液、膠體液或血液制品