第六节肠结核及结核性腹膜炎病人的护理PPT课件

Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety肠结核和结核性腹膜炎Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety肠结核定义：肠结核是结核分支杆菌感染引起的肠道慢性特异性感染性疾病，病变主要位于回盲部。临床上常有腹痛及腹部压痛、排便异常、腹部肿块和结核中毒症状。本病患者多为青壮年，20~40岁约占60~70%；女性多于男性，约呈3：1Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety（一）病因与发病机制致病菌–人型结核菌占绝大多数–牛型结核菌Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety感染途径（1）经口感染--主要途径•自身结核吞下带结核菌的痰•与肺结核病人共餐，吞下带菌食物•饮用结核杆菌污染的牛奶（2）血行播散：粟粒性肺结核，结核杆菌经血行播散至肠壁（3）直接蔓延：腹腔内邻近结核病灶（输卵管结核、肠系膜淋巴结核等）直接蔓延Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety类型：–溃疡性肠结核–增生型肠结核–混合性肠结核Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety（二）临床表现典型临床表现：腹痛排便异常腹部包块肠外结核的表现（全身症状）Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.InordertomeettheneedsofsocietyWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.InordertomeettheneedsofsocietyWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety3、腹部肿块主要见于增生型肠结核也可见于溃疡型肠结核和周围组织粘连，或并有肠系膜淋巴结核等，均可形成肿块而被扪及。腹块常位于右下腹，中等硬度，可有轻、中度压痛，有时表面不平，移动度小、边缘不甚规则、表面不平。Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety4、全身症状和肠外结核的表现溃疡型肠结核：常有结核毒血症，如午后低热，伴有盗汗，乏力，消瘦，贫血等症状和体征。增生型肠结核多无结核中毒症状，病程较长，全身情况较好。Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety5、并发症（1）肠梗阻：最常见，主见增生型原因：肉芽组织增生溃疡瘢痕收缩（2）肠出血：少见（3）肠穿孔Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety（三）辅助检查（1）实验室检查血常规：贫血，WBC正常，淋巴细胞↑血沉ESR：明显↑结核菌素试验：强阳性粪便检查常规：糊状、少量WBC、RBC病原：结核杆菌（+）Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety（2）X线检查钡餐透视—首选溃疡型：激惹征象—跳跃征增生型：肠腔狭窄充盈缺损Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety（3）结肠镜检查临床意义：有确诊价值镜下表现：肠粘膜充血、水肿环绕肠周溃疡（边缘呈鼠咬状）炎性息肉肠腔狭窄组织学检查：干酪性肉芽肿结核杆菌溃疡肉芽肿Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety（四）治疗要点1、抗结核药物治疗（1）用药原则：早期、适量、规律、联合、全程。（2）联合用药：三或四联，疗程：6～9月（3）用药方法：同肺TBWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety2、对症治疗（1）休息：活动性者：卧床休息（2)饮食：高营养、富含维生素、易消化不能进食者：静脉高营养(3)支持治疗:给予阿托品等抗胆碱能药物缓解腹痛；纠正水、电解质与酸碱失衡；不完性肠梗阻时可行胃肠减压Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety3、手术治疗①急性肠穿孔②完全性肠梗阻③肠道大量出血内科积极抢救不能止血者④肠瘘内科治疗未能闭合者Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety结核性腹膜炎Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety结核性腹膜炎定义：结核性腹膜炎是由结核分枝杆菌感染引起的腹膜慢性弥漫性炎症。发病情况：我国常见病之一，中青年多见，女性多见，男女比1：2。Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety（一）病因及发病机制病因：由结核分枝杆菌感染腹膜引起。感染途径：直接蔓延为主肠系膜淋巴结结核、卵巢输卵管结核、肠结核为常见原发病。血行播散少见活性肺结核，关节、骨、睾丸结核等。并可伴结核性多浆膜炎、结核性脑膜炎。Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety病理本病病理特点：渗出、粘连、干酪三型，前两型多见，粘连型最多，其次为渗出在本病的发展过程中可两型或三型病变并存，称为混合型。Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety1、症状：（1）全身症状：结核中毒症状发热和盗汗。低热或中度发热为主，1/3可有驰张热，少数稽留热。后期营养不良（消瘦、疲乏、浮肿、贫血、舌炎、口角炎等）。（二）临床表现Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety（2）腹痛：早期腹痛不明显，以后持续性隐痛或钝痛，少数也可无腹痛出现。部位在脐周、下腹，有时全腹。当发生肠梗阻时，可出现阵发性绞痛。（二）临床表现Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety（3）腹泻：腹泻常见，3～4次/日。呈糊样。原因与腹膜炎所致的肠功能紊乱有关；部分病人有腹泻及便秘交替。（4）可伴有腹胀。