护士执业资格考试外科护理学(8).ppt

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1、张某，男性，48岁阵发性腹痛、恶心、呕吐、停止排便、排气三天。2年前曾行阑尾切除术。入院检查：T37.8℃P110次/分BP16/11Kpa呈急性病容，神志清Casestudy腹部膨隆见肠型及蠕动波，肠鸣音亢进有气过水声，腹部压痛明显，以右侧腹为重，有轻度腹肌紧张及反跳痛，叩诊为鼓音。X线：肠胀气，肠管增粗并有液平面。血液检查：WBC13×109/LN92%Na+120mmol/LK+3.0mmol/L血糖10.5mmol/LCasestudy肠梗阻IntestinalobstractionWhenevergastrointestinalluminalcontentispa

2、thologicallypreventedfrompassingdistallyConception任何原因引起的肠内容物不能正常运行，顺利通过肠道时，称为肠梗阻（intestinalobstruction)。1.AccordingtoitsBasiccauses2.Vascularsupplytointestinalwall3.Obstructionlevelorsite4.Theextentofobstruction5.ProgressionofobstructionClassification１.AccordingtoitsBasiccauses机械性肠梗阻（mech

3、anicalobstruction）动力性肠梗阻（dynamicobstruction）血运性肠梗阻（obstructionofvascularsupplyorigin）ClassificationClassificationmechanicalobstruction（verycommon)A.肠腔堵塞B.肠管受压粘连带压迫ascaridherniamechanicalobstructionC.肠壁病变inflammatoryneoplasticClassificationDynamicobstructionCauses:Nervalreflexortoxinstimula

4、tionClassification麻痹性肠梗阻（Paralyticileus）：acutediffuseperitonitis,abdominaloperation,retroperitonealhematomaandinfection痉挛性肠梗阻（Spasticobstruction）ClassificationObstructionofvascularsupplyoriginthrombosisorembolism,thenintestinalparalysisClassification1.按梗阻发生的原因2.按肠壁有无血运障碍单纯性肠梗阻(Simpleobstru

5、ction)绞窄性肠梗阻(Strangulationobstruction)IntussceptionVolvulusClassification1.AccordingtoitsBasiccauses2.Vascularsupplytointestinalwall3.按梗阻发生的部位高位肠梗阻(highobstruction)低位肠梗阻(lowobstruction)Classification1.AccordingtoitsBasiccauses2.Vascularsupplytointestinalwall3.Obstructionlevelorsite4.按梗阻发生的

6、程度完全性肠梗阻(completeobstruction)不完全性肠梗阻(Incompleteobstruction)Classification1.AccordingtoitsBasiccauses2.Vascularsupplytointestinalwall3.Obstructionlevelorsite4.Theextentofobstruction5.按梗阻发生的速度急性肠梗阻(Acuteobstruction)慢性肠梗阻(chronicobstruction)ClassificationPathophysiologySimplemechanicalobstruc

7、tion梗阻以上肠蠕动增多(contractsvigorously)梗阻以上肠管膨胀(distention)梗阻以下肠管瘪陷膨胀和瘪陷交界处为梗阻所在肠管局部变化PathophysiologyAcutecompleteobstruction肠腔压力↑→静脉回流受阻→肠壁水肿、增厚、呈暗红色→动脉血运受阻→肠管变成紫黑色→坏死、穿孔。Pathophysiology肠管局部变化Chronicincompleteobstruction梗阻以上肠腔扩张、肠壁代偿性肥厚腹壁视诊常可见扩大的肠型和肠蠕动坡。Pathophysi