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急性化脓性腹膜炎图文课件

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急性化脓性腹膜炎PPT课件 急性化脓性腹膜炎 急性化脓性腹 急性化脓性腹膜炎课件 急性化脓性腹膜炎图文 急性化脓性腹膜炎ppt 课件急性化脓性腹膜炎
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Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 急性化脓性腹膜炎 acute suppuative peritonitis Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 解剖生理概要 壁腹膜 •腹膜 脏腹膜 腹腔 腹膜腔 网膜囊 在正常情况下,腹腔内有75—100ml黄色 澄清液体,起润滑作用。在病变时,腹膜腔可容 纳数升液体或气体。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. • 大 网 膜 自 横 结 肠 下 垂 遮 盖 其 下 的 脏 器 。 大 网 膜 有 丰 富 的 血 液 供 应 和 大 量 的 脂 肪 组 织 , 活 动 度 大 , 能 够 移 动 到 所 及 的 病 灶 处 将 其 包 裹 、 填 塞 , 使 炎 症 局 限 , 有 修 复 病 变 和 损 伤 的 作 用 。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. •神 经 支 配 : 壁 腹 膜 — — 体 神 经 ( 肋 间 神 经 和 腰 神 经 的 分 支 ) 的 支 配 , 对 各 种 刺 激 敏 感 , 定 位 准 确 。 腹 前 壁 腹 膜 在 炎 症 时 , 可 引 起 局 部 疼 痛 、 压 痛 和 反 射 性 的 腹 肌 紧 张 , 是 诊 断 腹 膜 炎 主 要 的 临 床 依 据 。 膈 肌 中 心 部 分 的 腹 膜 受 到 刺 激 时 , 通 过 膈 神 经 的 反 射 可 引 起 肩 部 放 射 性 痛 或 打 嗝 。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 脏腹膜——自主神经支配,来自交感神经和 迷走神经末梢。 对牵引、胃肠腔内压力增加或炎症、压 迫等刺激较为敏感,其性质常为钝痛而定 位较差,多感觉局限于脐周腹中部。 重刺激时常可引起心率变慢、血压下降 和肠麻痹。 如急性阑尾炎的转移性右下腹疼痛 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 腹膜的生理作用: ①润滑作用 ②吸收和渗出作用 ③防御作用 ④修复作用 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 急性弥漫性腹膜炎 acute diffuse peritonitis Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 分 类 : ( c l a s s i f i c a t i o n ) 1.按病因分类: 细菌性和非细菌性 2.按临床经过分类: 急性、亚急性和慢性 3.按发病机制分类: 原发性和继发性 4.按累及范围分类: 弥漫性和局限性 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 病因: 1.继发性腹膜炎(最常见) (secondary peritonitis) (1)腹腔内器官穿孔,损伤引起的腹壁或内脏 破裂; (2)腹内脏器炎症扩散如急性阑尾炎、急性胰 腺炎、妇科化脓性感染; (3)腹部手术中污染腹腔,胃肠道、胆管、胰 管吻合口漏,腹前、后壁的严重感染均可引起 腹膜炎。 主要病原菌:消化道常驻菌群(大肠杆菌、厌 氧拟杆菌、链球菌、变形杆菌) Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 继发性腹膜炎常见原因 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 2 . 原 发 性 腹 膜 炎 ￿￿ ( p r i m a r y p e r i t o n i t i s ) 细 菌 进 入 腹 腔 途 径 : ( 1 ) 血 行 播 散 ( 2 ) 上 行 性 感 染 ( 3 ) 直 接 扩 散 ( 4 ) 透 壁 性 感 染 病 源 菌 : 溶 血 性 链 球 菌 、 肺 炎 双 球 菌 或 大 肠 杆 菌 。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 病理生理 腹腔内进入细菌或胃肠内容物后,腹膜充 血、水肿,并失去原有的光泽。接着产生大量 清晰的浆液性渗出液,以稀释腹腔内的毒素。 大量巨噬细胞、中性粒细胞渗出,加以坏 死组织、细菌和凝固的纤维蛋白,使渗出液变 为浑浊而成为脓液。 大肠杆菌脓液呈黄绿色,常与其他致病菌 混合感染而稠厚,有粪便的特殊臭气。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 腹 膜 炎 的 结 局 的 决 定 因 素 : 1 、 病 人 全 身 的 和 腹 膜 局 部 的 防 御 能 力 ; 2 、 污 染 细 菌 的 性 质 、 数 量 和 时 间 。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 发 热 、 呕 吐 、 肠 管 麻 痹 , 肠 腔 内 大 量 积 液 使 血 容 量 明 显 减 少 。 肠 管 因 麻 痹 而 扩 张 、 胀 气 , 使 膈 肌 抬 高 而 影 响 心 肺 功 能 , 使 血 液 循 环 和 气 体 交 换 受 影 响 , 加 重 休 克 而 导 致 死 亡 。 年 轻 体 壮 、 抗 病 能 力 强 者 , 可 使 细 菌 毒 力 减 弱 , 炎 症 消 散 、 局 限 或 形 成 脓 肿 。 腹 膜 炎 治 愈 后 , 腹 腔 粘 连 。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 急性腹膜炎的病理生理 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 临床表现 (clinical situation) 1. 腹痛 一般都很剧烈,不能忍受,呈持续性。 深呼吸、咳嗽、转动身体时疼痛加剧。病人多 不愿改变体位。 2. 恶心、呕吐 早期为腹膜受到刺激,引起反射 性恶心。晚期为发生溢出性呕吐。 3. 体温、脉搏 开始正常,以后即逐渐升高。年 老体弱的病人体温可不升高。脉搏多加快;如 脉搏快体温反而下降,这是病情恶化征象之一 。 4.感染中毒症状 严重时出现高热、脉速、呼 吸浅快、大汗、口干。后期重度缺水、代谢性 酸中毒及休克。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 腹部体征: 视:明显腹胀,腹式呼吸减弱或消失。腹胀加 重是病情恶化的重要标志。 触:压痛、反跳痛、肌紧张是腹膜炎的主要标 志,腹肌紧张,其程度随病因与病人全身情况不 同而轻重不一。 叩:鼓音——胃肠胀气 肝浊音界缩小或消失——穿孔 腹腔内积液较多时可叩出移动性浊音。 听:肠鸣音减弱,肠麻痹时肠鸣音消失。 直肠指检:直肠前窝饱满及触痛,这表示盆腔已 有感染或形成盆腔脓肿。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 辅助检查: 1.血液分析: 白细胞计数及中性粒细胞比例增高。病情险恶 或机体反应能力低下的病人,白细胞计数不增高 ,仅中性粒细胞比例增高,甚至有中毒颗粒出现 。 2.腹部立位平片: 小肠普遍胀气并有多个小液平面的肠麻痹征象 。 胃肠穿孔时多数可见有隔下游离气体。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 3.B超检查:腹腔积液 4.腹穿 5.CT 6.直肠指诊 7.阴道检查或后穹隆穿刺 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 腹腔穿刺: 1.结核性腹膜炎有草绿色透明腹水。 2.胃十二指肠急性穿孔抽出液呈黄色、浑 浊、含胆汁、无臭气。饱食后穿孔时可 含食物残渣。 3.急性阑尾炎穿孔时抽出液为稀脓性略带 臭气。 4.绞窄性肠梗阻抽出液为血性、臭气重。 5.出血性坏死性胰腺炎抽出液为血性,胰 腺淀粉酶含量高。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 诊 断 (diagnosis) 1、病史 2、体征 3、辅助检查 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 治 疗 (treatment) 1.非手术疗法(多为原发性腹膜炎) 适应症:病情较轻、或病史较长超过24小 时,且腹部体征已减轻或有减轻趋势者(如原 发性腹膜炎、盆腔炎、疾病初期病因不明、病 情不重者)。 (l)体位: (2)禁食、胃肠减压: (3)纠正水电解质紊乱: (4)抗生素: (5)补充热量和营养: (6)镇定、止痛、吸氧: Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 2.手术治疗(继发性腹膜炎) 手术疗法指征: (1)经非手术治疗6~8小时后(一般不超过12 小时),症状及体征不缓解反而加重者; (2)腹腔内原发病严重,如腹腔内脏器损伤破 裂,绞窄性肠梗阻,胃肠道或胆管坏死穿孔, 胃肠手术后短期内吻合口漏所致的腹膜炎; (3)腹膜炎重,腹腔积液多,肠麻痹重或中毒 症状严重,尤其是有休克表现者。 (4)腹膜炎病因不明,无局限趋势 。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 手术治疗方法 (1)麻醉方法: (2)处理原发病: (3)清理腹腔: (4)引流: Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 处理原发病: 切口选择: 病变部位、旁正中切口、二次手术切口。 探查: 保护肠管、不要过多地解剖和分离以免感染扩 散、为了找到病灶可分离一部分粘连。 处理方法: 胃十二指肠溃疡穿孔,穿孔时间不超过12小时 ,可做胃大部切除术。 胆囊炎、阑尾炎:一期切除术;局部炎症严重 ,解剖层次不清,全身情况不能耐受手术时,行腹 腔引流或胆囊造口术。 肠管坏死行坏死肠管切除术、造口术等 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 清理腹腔: 开腹后立即用吸引器吸净腹腔内的脓液 及液体,清除食物残渣、粪便、异物等。脓液 多积聚在病灶附近、隔下、两侧结肠旁沟及盆 腔内。 可用甲硝唑及生理盐水灌洗腹腔至清洁 。病人高热时可用4~10℃生理盐水灌洗,有 助于降温。 腹内有脓苔、假膜和纤维蛋白分隔时,应 予清除以利引流。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 充分引流: 目的:把腹腔内的残留液和继续产生的渗液引出体 外,以防止发生腹腔脓肿。 引流物: 引流指征: ①坏死病灶未能切除或有大量坏死组织无法清除; ②坏死病灶已切除或穿孔已修补,预防发生漏液; ③手术部位有较多的渗液或渗血; ④已形成局限性脓肿。 拔出引流管指征: 引流量少(10ml)、非脓性、无发热、腹胀等 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 腹 腔 脓 肿 abdominal abscess Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 膈下脓肿subphrenic abscess 膈下脓肿 盆腔脓肿 肠间脓肿 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 膈下间隙 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 左肝上间隙 肝上间隙 右肝上间隙 膈下间隙 左肝下前间隙 (结肠上间隙) 左肝下间隙 肝下间隙 左肝下后间隙 右肝下间隙 腹膜外间隙(冠状韧带两层之间) Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 病 理 1.感染途径 (1)急性腹膜炎脓液积聚(多见) (2)细菌经门静脉和淋巴系统到达 2.发生率 70%急性腹膜炎的病人经手术或药物治 疗后腹腔内的脓液被完全吸收;30%发生局限 性脓肿。 3.脓肿的位置 十二指肠溃疡穿孔、胆管化脓性疾病、阑 尾炎穿孔,脓肿常发生在右膈下;胃穿孔、脾切 除术后感染,脓肿常发生在左膈下。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 4.转归 (1)小脓肿经非手术治疗可被吸收。 (2)大脓肿,长期感染衰竭,死亡。 膈下感染可引起反应性胸腔积液,或经 淋巴蔓延到胸腔引起胸膜炎;亦可穿入胸腔引 起脓胸。 个别的可穿透结肠形成内屡而“自家”引 流。 腐蚀消化道管壁引起消化道反复出血和 肠瘘、胃瘘。 如病人的身体抵抗力低下可发生脓毒血 症。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 临床表现 ①全身症状: 发热,初为弛张热,脓肿形成以后持 续高热,也可为中等程度的持续发热。 脉率增快,舌苔厚腻。 逐渐出现乏力、衰弱、盗汗、厌食、 消瘦、白细胞计数升高、中性粒细胞比 例增加。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. ②局部症状: 脓肿部可有持续钝痛,咳嗽、深呼吸时 加重。疼痛常位于近中线的肋缘下或剑突 下。 脓肿位于肝下靠后方可有肾区痛,有时 可牵涉到肩、颈部。 脓肿刺激膈肌可引起呃逆。 膈下感染可通过淋巴引起胸膜反应,出 现胸水,咳嗽、胸痛。脓肿穿破到胸腔发 生脓胸。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 诊断和鉴别诊断 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 1 . 病 史 : 急 性 腹 膜 炎 或 腹 腔 内 脏 器 的 炎 症 性 病 变 经 治 疗 好 转 后 , 或 腹 部 手 术 数 日 后 , 出 现 发 热 腹 痛 。 2 . X 线 透 视 : 患 侧 膈 肌 升 高 , 随 呼 吸 活 动 度 受 限 或 消 失 , 肋 膈 角 模 糊 , 积 液 。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 3.X线摄片 发现胸膜反应,胸腔积液,肺下叶部分 不张等; 膈下可见占位阴影。 左膈下脓肿,胃底可受压下降移位; 脓肿含气者可有液气平面。 4.B超检查: 可发现液性平段及脓肿的部位和大小。 5.CT检查 定位可靠,可以看出脓肿与周围脏器的 关系。 Through this publicity
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