胆结石的护理查房课件

Throughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.普外一科——6heart胆结石患者护理查房兰州大学第二临床医学院2010级护理薛敏Throughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.Chp1病例概要Chp2疾病简介Chp5术前护理Chp6术后护理Chp3相关检查Chp4治疗原则Chp7康复宣教目录页CONTENTSPAGEThroughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.Chapter.1病例概要过渡页TRANSITIONPAGE4Chp1知识概述Throughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.1.1病情介绍：病情介绍Thediseaseprofile•患者贾当杏，女，65岁；•因“间断性右上腹疼痛伴肩背部疼痛2年余，加重一周”，于2014年8月5日入院，我科以“胆囊结石”收住；•入院生命体征：T36.4℃P78次/分R19次/分Bp120/70mmHg;•查体阳性体征：右上腹压痛，Murphy征阳性。病情介绍5Chp1知识概述Throughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.1.1病情介绍：诊疗过程•2014年8月5日（入院当天）•遵医嘱予以抗生素抗感染、静脉营养、保胃、保肝退黄治疗并完善相关检查；•8月8日申请腹部“胆总管探查术”;•8月11日病人在全麻下行“胆囊切除术、胆总管探查术、腹腔引流术”，术晨给胃肠减压、留置导尿。病情介绍6Chp1知识概述Throughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.1.1病情介绍：病情介绍Thediseaseprofile•患者贾当杏，女，65岁；•因“间断性右上腹疼痛伴肩背部疼痛2年余，加重一周”，于2014年8月7日入院，我科以“胆囊结石”收住；•入院生命体征：T36.4℃P78次/分R19次/分Bp120/70mmHg;•查体阳性体征：右上腹压痛，Murphy征阳性。病情介绍Throughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.Chapter.2疾病简介过渡页TRANSITIONPAGE8Chp2实施原则Throughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.1胆石症是弹道系统多发病和多发病胆石症（cholelithiasis）:指发生于胆囊和胆管内的结石。是胆道系统常见病和多发病。•发病率：我国0.9%~10.1%，平均5.6%；•女：男=2.57:1；•趋势：胆管胆色素结石→胆囊胆固醇结石；9Chp1知识概述Throughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.1.4结石分类按化学成分按所在部位10Chp1知识概述Throughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.胆石成因胆道感染多为胆色素结石代谢因素胆道异物寄生虫、胆道术后线结可为结石核心胆道梗阻胆汁淤积，细菌作用形成胆色素结石胆囊功能异常收缩功能减退，胆汁淤滞其他胆汁中胆固醇过饱和，析出、沉淀、结晶雌激素促进胆固醇过饱和；遗传...Throughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.Chapter.3相关检查过渡页TRANSITIONPAGE12Chp2实施原则Throughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.1B超是诊断胆道疾病的首选方法超声提示：1，胆囊结石伴慢性胆囊炎2，胆总管扩张——中上段结石可能（不排外胆泥组织）3，肝、胰未见明显异常•优点：无创、简便、可重复、经济且准确率高；•术中可提高肝胆疾病诊断率，评估病变切除的可能性；•胆管结石术后判定再有无结石；13Chp2实施原则Throughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.4实验室检查阳性指标：RBC2.77x10~12/LTBIL36.5umol/LDBIL12.2umol/LIBIL24.3umol/L14Chp2实施原则Throughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.3MRCPMRCP印象：1，多发结石2，胆总管末端可疑小结石，致肝外胆管轻度扩张；建议ERCP检查。•优点：无创、胆道成像完整；•术中可提高肝胆疾病诊断率，评估病变切除的可能性；•胆管结石术后判定再有无结石；Throughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.Chapter.4治疗原则过渡页TRANSITIONPAGE16Chp4服务方式Throughthispublicitycampaign,furtherimprovethesenseofbusinessintegr