常見癥狀胸痛課件

匯報(bào)人：xxx20xx-03-15常見癥狀胸痛ppt課件目錄胸痛概述急性胸痛鑒別診斷慢性胸痛鑒別診斷輔助檢查在胸痛診斷中的應(yīng)用胸痛的治療原則與方法胸痛預(yù)防措施及生活建議01胸痛概述胸痛是一種常見病癥，指胸部區(qū)域的疼痛感或不適感。胸痛定義根據(jù)疼痛性質(zhì)、持續(xù)時(shí)間和伴隨癥狀，胸痛可分為非心源性胸痛和心源性胸痛兩大類。胸痛分類胸痛定義與分類胸痛的發(fā)病原因復(fù)雜多樣，包括心血管疾病、呼吸系統(tǒng)疾病、消化系統(tǒng)疾病、胸壁疾病等。其中，急性冠脈綜合征、主動(dòng)脈夾層、肺栓塞等是危及生命的胸痛主要原因。發(fā)病原因高齡、高血壓、糖尿病、高脂血癥、吸煙等是胸痛發(fā)病的危險(xiǎn)因素。此外，長期精神緊張、過度勞累等也可能誘發(fā)胸痛。危險(xiǎn)因素發(fā)病原因及危險(xiǎn)因素以下附贈(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.臨床表現(xiàn)胸痛的臨床表現(xiàn)各異，可能伴隨胸悶、氣短、心悸、咳嗽等癥狀。根據(jù)疼痛性質(zhì)可分為鈍痛、銳痛、壓痛等；根據(jù)持續(xù)時(shí)間可分為短暫性胸痛、持續(xù)性胸痛等。診斷依據(jù)胸痛的診斷需結(jié)合患者病史、體格檢查、影像學(xué)檢查等多方面資料。心電圖、胸部X線、CT等影像學(xué)檢查對(duì)于胸痛的診斷具有重要意義。同時(shí)，血液學(xué)檢查如心肌酶譜、D-二聚體等也有助于胸痛的鑒別診斷。臨床表現(xiàn)與診斷依據(jù)02急性胸痛鑒別診斷包括不穩(wěn)定型心絞痛和心肌梗死，表現(xiàn)為胸骨后壓榨性疼痛，常放射至左肩、左臂內(nèi)側(cè)達(dá)無名指和小指，或至頸、咽或下頜部。急性冠脈綜合征（ACS）胸痛一開始即達(dá)高峰，常放射到背、肋、腹、腰和下肢，兩上肢的血壓和脈搏可有明顯差別。主動(dòng)脈夾層胸痛與發(fā)熱同時(shí)出現(xiàn)，呼吸和咳嗽時(shí)加重，早期即有心包摩擦音。急性心包炎心血管源性胸痛表現(xiàn)為突然發(fā)生的胸痛、呼吸困難、咯血等癥狀，常有下肢或盆腔血栓性靜脈炎、骨折等病史。肺栓塞（PE）氣胸胸膜炎胸痛突然發(fā)生，呼吸和咳嗽時(shí)加重，患側(cè)肺呼吸音減弱或消失，叩診呈鼓音。胸痛與呼吸有關(guān)，吸氣時(shí)加重，呼氣時(shí)減輕，可伴有發(fā)熱、咳嗽等癥狀。030201呼吸系統(tǒng)源性胸痛如食管炎、食管裂孔疝等，胸痛常位于胸骨后，呈燒灼樣痛，可伴有吞咽困難。食管疾病如膽囊炎、膽石癥等，胸痛常位于右肋緣下，可放射至右肩背部。肝膽疾病如急性胰腺炎等，胸痛常位于左上腹，可向左肩及左腰背部放射。胰腺疾病消化系統(tǒng)源性胸痛其他原因引起的胸痛胸壁疾病如肋間神經(jīng)痛、帶狀皰疹等，胸痛常沿肋間神經(jīng)分布，呈刺痛或灼痛。心理精神因素如焦慮、抑郁等情緒問題，也可引起胸痛癥狀，但常無明確器質(zhì)性病變。其他罕見病因如心臟神經(jīng)官能癥等，也可導(dǎo)致胸痛癥狀的出現(xiàn)。03慢性胸痛鑒別診斷心前區(qū)疼痛，多為壓榨性或緊縮性，可放射至左肩、左臂內(nèi)側(cè)甚至無名指和小指，持續(xù)數(shù)分鐘，休息或含服硝酸甘油可緩解。癥狀表現(xiàn)典型的心絞痛癥狀，結(jié)合年齡、冠心病危險(xiǎn)因素、心電圖改變等可做出診斷。必要時(shí)可行冠狀動(dòng)脈造影明確診斷。診斷依據(jù)需與急性冠脈綜合征、其他心臟疾病、消化系統(tǒng)疾病等引起的胸痛相鑒別。鑒別診斷慢性穩(wěn)定性心絞痛診斷依據(jù)無器質(zhì)性心臟病證據(jù)，結(jié)合臨床表現(xiàn)及心理測(cè)試可做出診斷。癥狀表現(xiàn)胸痛常位于心尖部或左乳房下，多為短暫刺痛或持續(xù)隱痛，常伴有心悸、氣短、失眠等癥狀。鑒別診斷需與器質(zhì)性心臟病、肋間神經(jīng)痛等相鑒別。心臟神經(jīng)官能癥癥狀表現(xiàn)01肋間神經(jīng)痛沿肋間神經(jīng)分布區(qū)疼痛，多為刺痛或灼痛，轉(zhuǎn)身、深呼吸、咳嗽時(shí)加重。肋軟骨炎則表現(xiàn)為肋軟骨ju部腫脹、疼痛，壓痛明顯。診斷依據(jù)02根據(jù)臨床表現(xiàn)及體格檢查可做出診斷，必要時(shí)可行影像學(xué)檢查排除其他病變。鑒別診斷03需與帶狀皰疹、胸膜炎等引起的胸痛相鑒別。肋間神經(jīng)痛與肋軟骨炎胃食管反流病表現(xiàn)為胸骨后燒灼感或疼痛，常伴有反酸、噯氣等癥狀，胃鏡檢查可明確診斷。肺栓塞表現(xiàn)為突發(fā)的胸痛、呼吸困難、咯血等癥狀，肺動(dòng)脈CTA檢查可明確診斷。肺癌胸痛常表現(xiàn)為胸部隱痛或鈍痛，可伴有咳嗽、咯血等癥狀，胸部CT檢查可發(fā)現(xiàn)肺部占位性病變。胸膜炎胸痛常位于腋前線或腋后線下方，為持續(xù)性銳痛，深呼吸或咳嗽時(shí)加重，可伴有發(fā)熱、咳嗽等癥狀，胸部X線或CT檢查可明確診斷。其他慢性胸痛的鑒別診斷04輔助檢查在胸痛診斷中的應(yīng)用常規(guī)心電圖用于診斷心肌缺血、心肌梗死、心律失常等心臟疾病。動(dòng)態(tài)心電圖可連續(xù)記錄24小時(shí)或更長時(shí)間的心電圖，有助于捕捉偶發(fā)、短陣的心律失常。運(yùn)動(dòng)負(fù)荷試驗(yàn)通過增加心臟負(fù)荷，誘發(fā)心肌缺血，進(jìn)而診斷冠心病。心電圖檢查03CT和MRI可清晰顯示心臟、大血管及周圍zu織的結(jié)構(gòu)，有助于診斷主動(dòng)脈夾層、肺栓塞等疾病。01X線胸片可顯示心臟大血管的大小、形態(tài)、位置和輪廓，能觀察心臟與毗鄰器官的關(guān)系和肺內(nèi)血管的變化。02超聲心動(dòng)圖可實(shí)時(shí)顯示心臟結(jié)構(gòu)和運(yùn)動(dòng)狀態(tài)，檢測(cè)心包積液及室壁瘤等。影像學(xué)檢查心肌酶學(xué)檢查如肌酸激酶、肌酸激酶同工酶等，用于診斷急性心肌梗死。D-二聚體檢測(cè)用于排除肺栓塞的可能性。血?dú)夥治鲇糜谂袛鄼C(jī)體是否存在酸堿平衡失調(diào)以及缺氧和二氧化碳潴留。實(shí)驗(yàn)室檢查是診斷冠心病的金標(biāo)準(zhǔn)，可明確病變范圍、程度，為介入治療或冠狀動(dòng)脈搭橋術(shù)提供依據(jù)。冠狀動(dòng)脈造影如心肌灌注顯像和心肌代謝顯像，可評(píng)估心肌的血流灌注和代謝情況。放射性核素檢查用于診斷和研究心律失常的一種方法，可明確心律失常的發(fā)生機(jī)制并確定其起源部位。心臟電生理檢查其他輔助檢查方法05胸痛的治療原則與方法快速識(shí)別并排除威脅生命的胸痛病因，如ACS、主動(dòng)脈夾層、肺栓塞等。首要目標(biāo)結(jié)合患者病史、體格檢查、心電圖和影像學(xué)檢查等，進(jìn)行綜合判斷。診斷方法根據(jù)診斷結(jié)果，采取針對(duì)性的治療措施，如溶栓、介入手術(shù)、藥物治療等。治療策略急性胸痛的治療原則針對(duì)不同類型的胸痛，選用相應(yīng)的藥物進(jìn)行治療，如硝酸酯類藥物、β受體阻滯劑、鈣通道阻滯劑等。包括介入手術(shù)、外科手術(shù)、氧療、機(jī)械通氣等非藥物治療方法，根據(jù)患者病情進(jìn)行選擇。藥物治療及非藥物治療選擇非藥物治療藥物治療對(duì)癥治療采用藥物治療、物理治療等方法，緩解疼痛癥狀，提高患者生活質(zhì)量。預(yù)防