常見癥狀嘔血課件

匯報人：xxx20xx-03-15常見癥狀嘔血ppt課件目錄嘔血基本概念及定義上消化道出血與嘔血關(guān)系鑒別診斷及輔助檢查方法治療原則與具體方法論述并發(fā)癥預(yù)防與處理策略患者日常管理與教育指導(dǎo)01嘔血基本概念及定義嘔血是指患者嘔吐出血液的現(xiàn)象，通常由上消化道出血引起。嘔血在醫(yī)學(xué)上稱為hematemesis，是指上消化道急性出血時，血液經(jīng)口腔嘔出的癥狀。嘔血定義與醫(yī)學(xué)術(shù)語醫(yī)學(xué)術(shù)語定義發(fā)病原因上消化道出血是嘔血的主要原因，包括食管、胃、十二指腸等部位的出血。此外，某些全身性疾病也可能導(dǎo)致嘔血。危險因素長期飲酒、吸煙、不規(guī)律飲食、消化道潰瘍、肝硬化等都是嘔血的危險因素。發(fā)病原因及危險因素以下附贈各項管理制度英文版（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)嘔血患者通常會出現(xiàn)嘔吐鮮紅色或咖啡色血液的癥狀，同時可能伴有頭暈、乏力、心悸等貧血表現(xiàn)。診斷依據(jù)醫(yī)生會根據(jù)患者的病史、癥狀、體征以及實驗室檢查結(jié)果來綜合判斷是否為嘔血。其中，胃鏡檢查是確診上消化道出血的重要手段之一。同時需要排除口腔、鼻、咽喉等部位的出血以及咯血的可能性。臨床表現(xiàn)與診斷依據(jù)02上消化道出血與嘔血關(guān)系當(dāng)上消化道出血后，血液在消化道內(nèi)積聚，當(dāng)積聚量達(dá)到250～300ml時，可刺激胃壁神經(jīng)而引起嘔吐反射，導(dǎo)致嘔血。消化道內(nèi)積血量達(dá)到一定程度出血部位在幽門以上時，血液容易反流入胃并刺激胃壁引起嘔吐，導(dǎo)致嘔血；若出血后立即嘔出，血液呈鮮紅色；若血液在胃內(nèi)停留一段時間，經(jīng)胃酸作用后再嘔出，則呈咖啡渣樣的棕褐色。出血部位與嘔吐關(guān)系上消化道出血導(dǎo)致嘔血機制123多表現(xiàn)為大量嘔血，顏色鮮紅或暗紅，常伴有黑便。食管胃底靜脈曲張破裂出血多表現(xiàn)為中量嘔血，顏色呈咖啡色或暗紅色，可伴有黑便。胃、十二指腸潰瘍出血多表現(xiàn)為少量持續(xù)性嘔血或黑便，顏色多呈暗紅色或黑色。胃癌出血不同部位上消化道出血特點如血小板減少性紫癜、白血病等，可導(dǎo)致凝血功能障礙，引發(fā)上消化道出血，進(jìn)而出現(xiàn)嘔血癥狀。血液系統(tǒng)疾病如流行性出血熱、鉤端螺旋體病等，可因全身性感染導(dǎo)致消化道黏膜損傷出血，嚴(yán)重時可出現(xiàn)嘔血。急性傳染病嚴(yán)重創(chuàng)傷、大手術(shù)、大面積燒傷等應(yīng)激狀態(tài)下，可出現(xiàn)消化道黏膜的急性糜爛性出血，導(dǎo)致嘔血癥狀。應(yīng)激性潰瘍?nèi)硇约膊∫饑I血可能性03鑒別診斷及輔助檢查方法03實驗室檢查通過血常規(guī)、凝血功能等實驗室檢查，排除因血液系統(tǒng)疾病導(dǎo)致的出血。01詢問病史了解患者是否有口腔、鼻、咽喉等部位出血的病史，如牙齦出血、鼻出血等。02ju部檢查對患者進(jìn)行口腔、鼻、咽喉等部位的ju部檢查，觀察是否有出血點或血腫形成。排除口腔、鼻、咽喉等部位出血詳細(xì)詢問患者病史，了解是否有呼吸系統(tǒng)疾病或心臟病史，以及咯血的特點和伴隨癥狀。病史采集體格檢查影像學(xué)檢查對患者進(jìn)行全面體格檢查，注意肺部聽診和心臟聽診，觀察是否有異常體征。通過胸部X線、CT等影像學(xué)檢查，明確肺部和心臟病變情況，有助于與嘔血進(jìn)行鑒別診斷。030201與咯血鑒別診斷要點影像學(xué)檢查對于無法耐受內(nèi)鏡檢查的患者，可選擇腹部超聲、CT等影像學(xué)檢查方法，了解腹部臟器和血管情況。內(nèi)鏡檢查對于疑似上消化道出血的患者，可進(jìn)行胃鏡檢查或十二指腸鏡檢查，直接觀察出血部位和病變情況。實驗室檢查通過大便隱血試驗、血常規(guī)等實驗室檢查方法，了解患者貧血程度和凝血功能狀態(tài)，有助于評估出血嚴(yán)重程度和制定治療方案。輔助檢查方法選擇與應(yīng)用04治療原則與具體方法論述主要采用抑制胃酸分泌、內(nèi)鏡治療、介入治療等措施。其中，抑制胃酸分泌是基礎(chǔ)治療，可降低胃內(nèi)酸度，促進(jìn)血小板聚集和纖維蛋白凝塊的形成，有助于止血和預(yù)防再出血。非靜脈曲張性出血應(yīng)盡早給予血管活性藥物如生長抑素、奧曲肽等，減少門靜脈血流量，降低門靜脈壓，從而止血。也可根據(jù)具體情況采用內(nèi)鏡下硬化劑注射或套扎治療等方法。靜脈曲張性出血針對不同病因治療策略內(nèi)科保守治療措施介紹一般治療患者應(yīng)臥床休息，保持呼吸道通暢，避免嘔血時血液吸入引起窒息，必要時吸氧。活動性出血期間禁食，嚴(yán)密監(jiān)測患者生命體征，如心率、血壓、呼吸、尿量及神志變化。藥物治療使用止血藥如維生素K1、酚磺乙胺等，以及抑制胃酸分泌的藥物如質(zhì)子泵抑制劑（PPI）或H2受體拮抗劑，以減少胃酸對胃黏膜的刺激和對血管的損傷。內(nèi)鏡治療對于非靜脈曲張性上消化道出血，內(nèi)鏡治療是首選方法。可通過內(nèi)鏡下的注射、熱凝、機械等方法止血。微創(chuàng)治療如經(jīng)頸靜脈肝內(nèi)門體分流術(shù)（TIPS），適用于肝硬化導(dǎo)致的食管胃底靜脈曲張破裂出血，可降低門靜脈壓力，達(dá)到止血目的。外科手術(shù)治療對于內(nèi)科保守治療和內(nèi)鏡治療無效的患者，或存在持續(xù)性出血、反復(fù)出血等情況，可考慮外科手術(shù)治療。手術(shù)方式包括胃大部切除術(shù)、賁門周圍血管離斷術(shù)等，具體應(yīng)根據(jù)患者病情和身體狀況選擇。內(nèi)鏡、微創(chuàng)或外科手術(shù)適應(yīng)癥05并發(fā)癥預(yù)防與處理策略大量嘔血可導(dǎo)致失血性休克，表現(xiàn)為血壓下降、心率加快、面色蒼白、四肢濕冷等癥狀。休克嘔血時血液誤入氣管，可引起窒息，嚴(yán)重時可危及生命。窒息大量血液在腸道內(nèi)分解，產(chǎn)生大量氨氣被吸收入血，可引起氮質(zhì)血癥，表現(xiàn)為惡心、嘔吐、昏迷等癥狀。氮質(zhì)血癥肝硬化患者食管胃底靜脈曲張破裂出血后，易誘發(fā)肝性腦病，表現(xiàn)為意識障礙、行為失常和昏迷等癥狀。誘發(fā)肝性腦病常見并發(fā)癥類型及危險因素積極治療原發(fā)病避免誘發(fā)因素定期檢查健康生活方式預(yù)防措施建議如消化性潰瘍、肝硬化等，以減少嘔血的發(fā)生。對于有嘔