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新生儿坏死性小肠结肠炎课件_6

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新生儿坏死性小肠结肠炎ppt 新生儿坏死性小肠结肠炎 新生儿坏死性小肠结肠炎ppt课件新生儿 新生儿坏死性小肠结肠炎课件
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单击此处编辑母版副标题样式 *1 单击此处编辑母版标题样式l 新生儿坏死性小肠结肠炎 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 查房目标 l1掌握新生儿坏死性小肠结肠炎的概念 l2掌握新生儿坏死性小肠结肠炎的临床表现 l3掌握新生儿坏死性小肠结肠炎的治疗及相关护理措施 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 拟题问题 l新生儿坏死性小肠结肠炎的定义 l新生儿坏死性小肠结肠炎的临床表现 l该患儿的护理诊断及护理措施 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 病史 l 患儿,男, 13小时。因腹胀、呕吐、解鲜血便 1小时入院。系G1P1孕36+6周,自然分娩,出生时Apgar评分10分,哭声可,面色红,生后混合喂养,奶量少,生后13小时患儿出现腹胀,吐黄绿色粘液,并排血便为进一步治疗收入。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 病史 l 入院查体:T37.8度 HR:126次/分 R:42次/分 BP:58/32mmHg 神志清,反应存,前囟平,面唇红,三角区青,哭声可,腹胀,脐结扎,肢端温,活动存,解血样便一次。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 病史 治疗: l禁食,胃肠减压 l一级护理,心电监护 l优立新,复达欣针抗感染,维生素K1止血,补液营养支持治疗 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society l血常规及血凝分析,活化部分凝血活酶时间APTT-sec 58.00 s,参考时间APTT-Ref 28.50 S ,血红蛋白137克每升,红细胞3.77*10的12次方每升, l血气分析示:PH 7.103, PCO2 33.7mmHg, BE -19mmol/L, HCO3 10.7mmol/L, GLU 453mg/dl ,Na 127mmol/L,K 4.6mmol/L,Hb 14.3g/dl With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 便隐血试验阳性。 l 粪便和血培养可阳性,以杆菌多见。 l X线检查 肠胀气:小肠为主,有多个液平(立位腹平片),肠曲间距增宽。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 概念 l 是围生期的多种致病因素导致的肠道疾病,多在出生后2周内发病,严重威胁新生儿的生命。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 病因 ①肠道供血不足,如新生儿窒息、肺透明膜病、脐动脉插管、红细胞增多症、低血压、休克等; ②饮食因素,如高渗乳汁或高渗药物溶液可损伤肠粘膜,食物中的营养物质有利于细菌生长和碳水化合物发酵产生氢气; ③细菌感染,如大肠杆菌、克雷白杆菌、绿脓杆菌、沙门氏菌、梭状芽胞杆菌等过度繁殖,侵入肠粘膜造成损伤,或引起败血症及感染中毒性休克加重肠道损伤 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 腹胀:首发症状,先有 胃排空延迟,而后全腹 胀,肠鸣音减弱或消失 临床表现 病情进展迅速、感染中毒症状严重 腹泻、血便 呕吐:可有胆汁或咖啡样 物 其他:隐匿发生者表现非特异性症状 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 临床表现 III A期 II B期 II A期 I期 喂养不耐受、反复胃 潴留、大便隐血阳性 显著腹胀 肠鸣音消失 肉眼血便 腹胀加重 腹壁、腹肌紧张 可触及包块 腹壁弥漫性 水肿、红斑 、变色、硬 结 III B期 腹壁紧 张 变色 腹水 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 辅助检查 l X线腹部平片检查对本症的诊断价值极大,如一次腹部平片无阳性发现时,应多次摄片连续观察其动态改变。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society X线检查 l1. 早期 l1)小肠轻中度胀气为主,结肠少气或无气或小肠结肠普遍胀气; l2)部分胀气的肠管可演变为外形僵硬、分节、管腔不规则或狭窄变细; l3)肠粘膜及肠间隙增厚、模糊; l4)胃泡多中度胀气部分有储留液。 l上述各异常影像的病理基础是粘膜及粘膜下层充血、水肿、出血、坏死。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society X线检查 l2.进展期 呈现典型NEC的X线征。 l1)肠管中度扩张,肠腔内可见多个细小液平面,呈阶梯状改变,提示病变累及肌层。 l2)粘膜下层可见肠壁囊样积气影像,表现为小囊泡或串珠状积气在粘膜下及浆膜下合并存在。 l3)门静脉积气影; l4)腹膜外积气或胃壁积气影像。 l5)腹腔积液或气腹影:肠穿孔常有气腹,腹膜炎时腹腔内有积液,可见下腹部密度较深。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society l腹立位片,胃泡扩大肠管胀气 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society l肠管胀气,肠壁积气,门静脉积气 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society l液气腹、胃壁积气 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 实验室检查: l1 粪便检查 l 潜血试验多阳性 ,粪便培养细菌多阳性。以大肠埃细菌、克雷白菌等多见。粪便镜检可见多量的红细胞、白细胞。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 实验室检查: l2 血象 l 白细胞增高,有核左移现象,血小板多降低。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 实验室检查: l3 血培养 l 如阳性大多为革兰氏阴性杆菌,与粪便培养可得一致细菌。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 实验室检查: l4 腹腔穿刺 l 穿刺液涂片及培养大多为杆菌。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 实验室检查: l5 腹部B超 l 有时可见肝实质及门脉内间歇出现气体栓塞,还有助于发现腹水和炎性团快。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 实验室检查: l6 超声心动图 l 有时可见下腔静脉内有微小气泡进入右心室。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 基本治疗方案 1 禁 食 肠 外 营 养 4 3 监测生命体征、 腹围、胃肠出血 情况 抗生素 5 监测出入水量 62 胃 肠 减 压 监测实验室指标 7 放射学检查 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 预防 : l1 预防早产。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 预防 : l2 提倡母乳喂养,必须人工喂养者(尤为早产儿)采用每次少量增乳量的喂养方案以降低发生NEC的危险。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 预防 : l3 孕妇产前应用糖皮质激素可加强肠能动性、降低肠道通透性、加速胃肠道酶的成熟并减少细菌的菌落形成。对母亲产前未接受糖皮质激素治疗的早产儿在出生后给以地塞米松2mg/kg.d静注,也可降低NEC的发病率及死亡率。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 护理诊断 l1体温过高 与细菌毒素有关 l2腹痛、腹胀 与肠壁组织坏死、感染有关 l3腹泻 与肠道炎症有关 l4体液不足 与腹泻、呕吐、禁食、胃肠减压有 关 l5营养不足 与腹泻、呕吐、长期禁食有关 l6潜在并发症 休克 与血容量下降、微循环障 碍有关 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 护理措施 l 1 监测体温 根据监测结果给予相应的物理降温或药物降温。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 护理措施 l 2 减轻腹胀、腹痛,控制腹泻 立即禁食,肠胀气明显者行胃肠减压,观察腹胀消退情况及引流物色、质、量。观察有无呕吐,呕吐时头偏向一侧,及时清理呕吐物,保持皮肤及床单元清洁。记录呕吐物的色、质、量,做好口腔护理。遵医嘱给予抗生素控制感染。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 护理措施 l 3 每次便后用温水清洗臀部,并涂油膏,减少大便对臀部的刺激,保持臀部皮肤的完整性。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 护理措施 l 4 补充液体,维持营养 禁食期间以静脉维持能量及水电解质平衡。腹胀消失、大便潜血转阴后逐渐恢复饮食。恢复喂养从水开始,开始只喂开水或5%葡萄糖水,喂2-3次后,如无腹胀或呕吐,再喂乳汁,以1:1奶开始,初为3-5ML,以后每次增加2ML,逐渐增加浓度及奶量。在调整饮食期间继续观察腹胀及大小便情况,发现异常立即与医生取得联系。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 护理措施 l 5补液期间应建立良好的静脉通路,合理安排滴速,准确记录24小时出入量。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 护理措施 l 6 密切观察病情 当患儿出现脉搏细数、血压下降、末梢循环衰竭等中毒性休克时,立即通知医生组织抢救。迅速补充有效循环量,改善微循环,纠正脱水、电解质紊乱及酸中毒,补充能量及营养。仔细观察、记录大便的次数、性质、颜色及量,了解大便变化过程。及时正确留取标本送验 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
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