胸壁、胸膜疾病課件

匯報(bào)人：xxx20xx-03-14胸壁、胸膜疾病ppt課件目錄胸壁疾病概述常見胸壁疾病介紹胸膜疾病概述常見胸膜疾病介紹胸壁、胸膜疾病的影像學(xué)檢查胸壁、胸膜疾病的治療與預(yù)防01胸壁疾病概述胸壁由胸椎、胸骨、肋骨及肋間zu織等構(gòu)成，為胸腔提供保護(hù)和支持。肋間zu織包括肋間肌、神經(jīng)、血管和淋巴管，負(fù)責(zé)胸壁的運(yùn)動(dòng)和感覺。胸壁內(nèi)襯以胸膜，與胸腔器官在形態(tài)結(jié)構(gòu)和功能上相互關(guān)聯(lián)。胸壁解剖與生理如漏斗胸、雞胸等，影響胸廓形態(tài)和呼吸功能。胸壁畸形如肋軟骨炎、肋間神經(jīng)炎等，引起疼痛和ju部炎癥。胸壁感染包括原發(fā)性腫瘤和轉(zhuǎn)移性腫瘤，如肋骨腫瘤、胸壁肉瘤等。胸壁腫瘤胸壁疾病分類以下附贈(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.先天性因素遺傳因素、胚胎發(fā)育異常等導(dǎo)致胸壁畸形。后天性因素外傷、感染、腫瘤等引起胸壁疾病。危險(xiǎn)因素長(zhǎng)期吸煙、環(huán)境污染、職業(yè)暴露等增加患胸壁疾病的風(fēng)險(xiǎn)。發(fā)病原因及危險(xiǎn)因素臨床表現(xiàn)觀察胸廓形態(tài)、觸摸ju部腫塊、聽診呼吸音等。體格檢查影像學(xué)檢查實(shí)驗(yàn)室檢查01020403血常規(guī)、腫瘤標(biāo)志物等檢查可輔助診斷胸壁疾病。疼痛、呼吸困難、ju部腫塊、胸廓形態(tài)改變等。X線、CT、MRI等檢查可顯示胸壁病變的位置和性質(zhì)。臨床表現(xiàn)與診斷方法02常見胸壁疾病介紹03先天性胸壁缺損先天性胸壁缺損是由于胚胎期胸壁發(fā)育障礙所致的一種罕見畸形。01漏斗胸胸骨中下部分向內(nèi)凹陷，相鄰肋軟骨也隨其凹陷，形成外觀形似漏斗狀的一種先天性胸廓畸形。02雞胸胸骨向前隆起畸形，狀如雞、鴿子之胸脯，故稱之為雞胸，是前胸壁第二種常見的胸廓畸形。先天性胸壁畸形脂肪瘤、纖維瘤、神經(jīng)纖維瘤、血管瘤、軟骨瘤等。纖維肉瘤、神經(jīng)纖維肉瘤、血管肉瘤、軟骨肉瘤、骨肉瘤、骨軟骨肉瘤及惡性骨巨細(xì)胞瘤等。胸壁腫瘤胸壁惡性腫瘤胸壁良性腫瘤癤、癰、皮下蜂窩織炎、急性乳腺炎、淋巴結(jié)炎、膿胸等。非特異性感染結(jié)核性胸膜炎、胸壁結(jié)核等。特異性感染胸壁感染胸壁創(chuàng)傷閉合性胸壁創(chuàng)傷皮膚完整，胸腔與外界不相通，但可合并胸內(nèi)臟器損傷。開放性胸壁創(chuàng)傷胸壁有傷口，胸腔與外界相通，多伴有胸內(nèi)臟器損傷。03胸膜疾病概述胸膜結(jié)構(gòu)胸膜是一層薄而光滑的漿膜，分為臟層和壁層，臟層胸膜覆蓋在肺表面，壁層胸膜貼附在胸壁內(nèi)面。生理功能胸膜腔內(nèi)含有少量漿液，起到潤(rùn)滑作用，減少呼吸時(shí)臟層和壁層胸膜之間的摩擦。胸膜解剖與生理如胸膜炎、結(jié)核性胸膜炎等，以胸膜充血、水腫、滲出為主要病理改變。炎癥性疾病如胸膜間皮瘤、轉(zhuǎn)移性胸膜腫瘤等，以胸膜細(xì)胞異常增殖為主要特征。腫瘤性疾病如氣胸、胸腔積液、胸膜肥厚、胸膜粘連等。其他疾病胸膜疾病分類123細(xì)菌、病毒、真菌等病原體感染可引起胸膜炎癥。感染性因素腫瘤、結(jié)締zu織病、尿毒癥等疾病可導(dǎo)致胸膜病變。非感染性因素吸煙、空氣污染、職業(yè)暴露等可能增加胸膜疾病的發(fā)生風(fēng)險(xiǎn)。危險(xiǎn)因素發(fā)病原因及危險(xiǎn)因素臨床表現(xiàn)胸膜疾病患者可出現(xiàn)胸痛、咳嗽、呼吸困難等癥狀，嚴(yán)重時(shí)可伴有發(fā)熱、乏力等全身癥狀。診斷方法根據(jù)病史、體格檢查、影像學(xué)檢查（如X線、CT等）和實(shí)驗(yàn)室檢查（如胸腔積液檢查等）進(jìn)行綜合判斷。臨床表現(xiàn)與診斷方法04常見胸膜疾病介紹ABCD胸膜炎定義胸膜炎是指由致病因素（通常為病毒或細(xì)菌）刺激胸膜所致的胸膜炎癥，又稱“肋膜炎”。癥狀臨床主要表現(xiàn)為胸痛、咳嗽、胸悶、氣急，甚至呼吸困難。分類根據(jù)胸腔內(nèi)有無液體積聚，可分為滲出性胸膜炎和干性胸膜炎。治療治療原則包括控制感染、引流胸腔積液以及促使肺復(fù)張、恢復(fù)肺功能等。定義分類癥狀治療胸膜腫瘤胸膜腫瘤是指發(fā)生于胸膜上的腫瘤，包括原發(fā)性和轉(zhuǎn)移性兩種。臨床表現(xiàn)因腫瘤類型和位置而異，常見癥狀包括胸痛、呼吸困難、咳嗽等。根據(jù)腫瘤性質(zhì)，可分為良性腫瘤和惡性腫瘤。治療原則包括手術(shù)切除、放療、化療等，具體方案需根據(jù)患者病情制定。胸腔積液是以胸膜腔內(nèi)病理性液體積聚為特征的一種常見臨床癥候。定義根據(jù)積液性質(zhì)，可分為漏出液和滲出液兩種。分類臨床表現(xiàn)因積液量和性質(zhì)而異，常見癥狀包括呼吸困難、胸痛、咳嗽等。癥狀治療原則包括針對(duì)病因的治療和對(duì)癥治療，如胸腔穿刺抽液、胸腔閉式引流等。治療胸腔積液氣胸是指氣體進(jìn)入胸膜腔，造成積氣狀態(tài)，稱為氣胸。定義分類癥狀治療根據(jù)發(fā)病原因，氣胸可分為創(chuàng)傷性氣胸和自發(fā)性氣胸兩種。臨床表現(xiàn)因氣胸類型和程度而異，常見癥狀包括胸痛、呼吸困難、刺激性咳嗽等。治療原則包括排氣療法、防止復(fù)發(fā)措施、手術(shù)療法及防治并發(fā)癥等，具體方案需根據(jù)患者病情制定。氣胸05胸壁、胸膜疾病的影像學(xué)檢查特殊體位X線片如側(cè)位、斜位等，有助于更好地觀察胸壁、胸膜的病變情況。造影檢查通過引入造影劑，增強(qiáng)病變組織與正常組織的對(duì)比度，提高病變的檢出率。常規(guī)胸部X線片可以顯示胸壁、胸膜的形態(tài)和位置，以及可能存在的鈣化、氣胸、胸腔積液等異常表現(xiàn)。X線檢查增強(qiáng)CT通過注射造影劑，觀察病變組織的血供情況，有助于鑒別診斷。三維重建技術(shù)利用CT數(shù)據(jù)進(jìn)行三維重建，立體地展示胸壁、胸膜的形態(tài)和結(jié)構(gòu)。高分辨率CT