常見癥狀嘔血課件

匯報人：xxx20xx-03-15常見癥狀嘔血ppt課件目錄嘔血基本概念及定義上消化道出血與嘔血關系鑒別診斷及輔助檢查方法治療原則與具體方法論述并發(fā)癥預防與處理策略患者日常管理與教育指導01嘔血基本概念及定義嘔血是指患者嘔吐出血液的現象，通常由上消化道出血引起。嘔血在醫(yī)學上稱為hematemesis，是指上消化道急性出血時，血液經口腔嘔出的癥狀。嘔血定義與醫(yī)學術語醫(yī)學術語定義發(fā)病原因上消化道出血是嘔血的主要原因，包括食管、胃、十二指腸等部位的出血。此外，某些全身性疾病也可能導致嘔血。危險因素長期飲酒、吸煙、不規(guī)律飲食、消化道潰瘍、肝硬化等都是嘔血的危險因素。發(fā)病原因及危險因素以下附贈各項管理制度英文版（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.護理文書書寫制度:

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.臨床表現嘔血患者通常會出現嘔吐鮮紅色或咖啡色血液的癥狀，同時可能伴有頭暈、乏力、心悸等貧血表現。診斷依據醫(yī)生會根據患者的病史、癥狀、體征以及實驗室檢查結果來綜合判斷是否為嘔血。其中，胃鏡檢查是確診上消化道出血的重要手段之一。同時需要排除口腔、鼻、咽喉等部位的出血以及咯血的可能性。臨床表現與診斷依據02上消化道出血與嘔血關系當上消化道出血后，血液在消化道內積聚，當積聚量達到250～300ml時，可刺激胃壁神經而引起嘔吐反射，導致嘔血。消化道內積血量達到一定程度出血部位在幽門以上時，血液容易反流入胃并刺激胃壁引起嘔吐，導致嘔血；若出血后立即嘔出，血液呈鮮紅色；若血液在胃內停留一段時間，經胃酸作用后再嘔出，則呈咖啡渣樣的棕褐色。出血部位與嘔吐關系上消化道出血導致嘔血機制123多表現為大量嘔血，顏色鮮紅或暗紅，常伴有黑便。食管胃底靜脈曲張破裂出血多表現為中量嘔血，顏色呈咖啡色或暗紅色，可伴有黑便。胃、十二指腸潰瘍出血多表現為少量持續(xù)性嘔血或黑便，顏色多呈暗紅色或黑色。胃癌出血不同部位上消化道出血特點如血小板減少性紫癜、白血病等，可導致凝血功能障礙，引發(fā)上消化道出血，進而出現嘔血癥狀。血液系統(tǒng)疾病如流行性出血熱、鉤端螺旋體病等，可因全身性感染導致消化道黏膜損傷出血，嚴重時可出現嘔血。急性傳染病嚴重創(chuàng)傷、大手術、大面積燒傷等應激狀態(tài)下，可出現消化道黏膜的急性糜爛性出血，導致嘔血癥狀。應激性潰瘍全身性疾病引起嘔血可能性03鑒別診斷及輔助檢查方法03實驗室檢查通過血常規(guī)、凝血功能等實驗室檢查，排除因血液系統(tǒng)疾病導致的出血。01詢問病史了解患者是否有口腔、鼻、咽喉等部位出血的病史，如牙齦出血、鼻出血等。02ju部檢查對患者進行口腔、鼻、咽喉等部位的ju部檢查，觀察是否有出血點或血腫形成。排除口腔、鼻、咽喉等部位出血詳細詢問患者病史，了解是否有呼吸系統(tǒng)疾病或心臟病史，以及咯血的特點和伴隨癥狀。病史采集體格檢查影像學檢查對患者進行全面體格檢查，注意肺部聽診和心臟聽診，觀察是否有異常體征。通過胸部X線、CT等影像學檢查，明確肺部和心臟病變情況，有助于與嘔血進行鑒別診斷。030201與咯血鑒別診斷要點影像學檢查對于無法耐受內鏡檢查的患者，可選擇腹部超聲、CT等影像學檢查方法，了解腹部臟器和血管情況。內鏡檢查對于疑似上消化道出血的患者，可進行胃鏡檢查或十二指腸鏡檢查，直接觀察出血部位和病變情況。實驗室檢查通過大便隱血試驗、血常規(guī)等實驗室檢查方法，了解患者貧血程度和凝血功能狀態(tài)，有助于評估出血嚴重程度和制定治療方案。輔助檢查方法選擇與應用04治療原則與具體方法論述主要采用抑制胃酸分泌、內鏡治療、介入治療等措施。其中，抑制胃酸分泌是基礎治療，可降低胃內酸度，促進血小板聚集和纖維蛋白凝塊的形成，有助于止血和預防再出血。非靜脈曲張性出血應盡早給予血管活性藥物如生長抑素、奧曲肽等，減少門靜脈血流量，降低門靜脈壓，從而止血。也可根據具體情況采用內鏡下硬化劑注射或套扎治療等方法。靜脈曲張性出血針對不同病因治療策略內科保守治療措施介紹一般治療患者應臥床休息，保持呼吸道通暢，避免嘔血時血液吸入引起窒息，必要時吸氧?；顒有猿鲅陂g禁食，嚴密監(jiān)測患者生命體征，如心率、血壓、呼吸、尿量及神志變化。藥物治療使用止血藥如維生素K1、酚磺乙胺等，以及抑制胃酸分泌的藥物如質子泵抑制劑（PPI）或H2受體拮抗劑，以減少胃酸對胃黏膜的刺激和對血管的損傷。內鏡治療對于非靜脈曲張性上消化道出血，內鏡治療是首選方法?？赏ㄟ^內鏡下的注射、熱凝、機械等方法止血。微創(chuàng)治療如經頸靜脈肝內門體分流術（TIPS），適用于肝硬化導致的食管胃底靜脈曲張破裂出血，可降低門靜脈壓力，達到止血目的。外科手術治療對于內科保守治療和內鏡治療無效的患者，或存在持續(xù)性出血、反復出血等情況，可考慮外科手術治療。手術方式包括胃大部切除術、賁門周圍血管離斷術等，具體應根據患者病情和身體狀況選擇。內鏡、微創(chuàng)或外科手術適應癥05并發(fā)癥預防與處理策略大量嘔血可導致失血性休克，表現為血壓下降、心率加快、面色蒼白、四肢濕冷等癥狀。休克嘔血時血液誤入氣管，可引起窒息，嚴重時可危及生命。窒息大量血液在腸道內分解，產生大量氨氣被吸收入血，可引起氮質血癥，表現為惡心、嘔吐、昏迷等癥狀。氮質血癥肝硬化患者食管胃底靜脈曲張破裂出血后，易誘發(fā)肝性腦病，表現為意識障礙、行為失常和昏迷等癥狀。誘發(fā)肝性腦病常見并發(fā)癥類型及危險因素積極治療原發(fā)病避免誘發(fā)因素定期檢查健康生活方式預防措施建議如消化性潰瘍、肝硬化等，以減少嘔血的發(fā)生。對于有嘔