胸外科护理查房最终版教学内容.ppt
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1、Page 1胸外科护理查房最终版Page 2CASE PatientYuWeichengmale17yearsWithpainatleftchestanddifficultybreathing,chestdistress10days.Pastmedicalhistory:Alwaysbodyhealth,denyhistoryofotherseriousdiseasesanddrugallergy.Historyofpresentdisease:Withoutanyobviouscause,hefeltpainattheleftchestanddifficultybreathing,chest
2、distress10daysago.Nofever,lowhead,cough,haemoptysis,lackofpower,nightsweatandsoon.Atfirstdidnotpayattentiontothese,butsymptomsfornoease.Achestradiographyshowedthattheleftlungtissuecompressionby85%.Physicalexamination:T37.3,P96/min,R20/min,BP140/80mmHgIntelligenceclear,trachealatthecenterofneck.Thele
3、ftbreathsoundsalittleweak.Diagnosticexamination:WBC11.4109,N8.05,L18.1Admissiondiagnosis:SpontaneousPneumothoraxPage 3病例病例患者:患者:余炜成,男,余炜成,男,1717岁岁 左侧胸痛、胸闷伴呼吸困难左侧胸痛、胸闷伴呼吸困难1010天。天。既往史:既往体健,否认其他重大疾病病史及既往史:既往体健,否认其他重大疾病病史及药物过敏史。药物过敏史。现病史:患者于现病史:患者于1010天前无明显诱因,自感左侧天前无明显诱因,自感左侧胸痛、胸闷,偶有呼吸困难,无发热、咳嗽、胸痛、胸闷,偶
4、有呼吸困难,无发热、咳嗽、咳痰、咯血、心慌、乏力、盗汗、声嘶等不适。咳痰、咯血、心慌、乏力、盗汗、声嘶等不适。起初未予注意,症状持续无明显缓解,胸片检起初未予注意,症状持续无明显缓解,胸片检查,提示:左侧肺组织压缩查,提示:左侧肺组织压缩85%85%左右。左右。体格检查:体格检查:T 37.3 T 37.3,P 96 P 96次次/分分 ,R 20R 20次次/分分 ,BP 140/83mmHg BP 140/83mmHg,神智清楚,皮肤巩膜无黄神智清楚,皮肤巩膜无黄染,气管居中,左侧呼吸音稍弱,未明显干湿染,气管居中,左侧呼吸音稍弱,未明显干湿罗音。罗音。辅助检查:辅助检查:WBC 11.4
5、 109,N 8.05,L WBC 11.4 109,N 8.05,L 18.1 18.1 入院诊断:入院诊断:左侧自发性气胸左侧自发性气胸Page 4Etiology and classification病因及分类病因及分类THE SPEAKER:THE SPEAKER:于广平于广平Page 5The cause of spontaneous pneumothoraxnClassification of one Spontaneous pneumothorax Trauma pneumothorax Artificial pneumothoraxnClassification of two
6、Closed pneumothorax Open pneumothorax Tension pneumothoraxPage 6The cause of spontaneous pneumothoraxnWhen a trigger causes alveolar pressure rise sharply,lesions of the lung and pleural rupture occurs,the pleural cavity is communicated with the air,airflow will flow into the thorax lead to the form
7、ation of spontaneous pneumothorax.Clinical manifestations临床表现与体征临床表现与体征蒋娟蒋娟Page 8Clmical manifestations (临床表现)(临床表现):Suddenchestpain(突(突然发生胸痛),然发生胸痛),difficultyinbreathing(呼吸困难),(呼吸困难),chesttightness(胸闷胸闷),inseverecasesirritability、profusely、cyanosis(严重(严重者烦躁不安、大汗、紫绀)者烦躁不安、大汗、紫绀)acceleratedrespirati
8、on(呼(呼吸加快),吸加快),pulsebreakdownandevendeath(脉搏细数甚至死亡)。(脉搏细数甚至死亡)。Page 9Signs(体征):(体征):Fracheal shift to the contralateral(气管向健侧移(气管向健侧移位)。位)。Ipsilateral chest full(患侧胸部饱满)(患侧胸部饱满)weakening or disappearance of resiratory motion(呼吸运动减弱或消失)(呼吸运动减弱或消失)。Percussion drum sound(叩诊呈鼓音),(叩诊呈鼓音),fremitus and de
9、creased breath sound(语颤呼吸音减弱)。(语颤呼吸音减弱)。Auxiliary examination 辅助检查辅助检查THESPEAKER :桓秀山桓秀山10 Auxiliary examination1.X-ray 2.CT 3.Pleural cavity angiography4.Thoracoscopic11Auxiliary examination1 1.X-ray examination is the most.X-ray examination is the most reliable method of diagnosis of reliable meth
10、od of diagnosis of pneumothorapneumothoran nTypical pneumothorax X-ray Typical pneumothorax X-ray findings of the pneumothorax part findings of the pneumothorax part through the brightness increase,no through the brightness increase,no markings,the pulmonary hilar markings,the pulmonary hilar atroph
11、y,higher density,and the atrophy,higher density,and the edge of the visible hairline-like edge of the visible hairline-like visceral pleura shadow;visceral pleura shadow;n nContralateral lung compensatory Contralateral lung compensatory emphysema,lung markings;emphysema,lung markings;n nTrachea with
12、 Concurrent pleural Trachea with Concurrent pleural fluid or blood,fluid levels can be fluid or blood,fluid levels can be seen.seen.n nmediastinal shift to the mediastinal shift to the contralateral;contralateral;nX线检查是诊断气胸最可靠的方线检查是诊断气胸最可靠的方法。法。n典型的气胸典型的气胸X线表现为气胸部分线表现为气胸部分透亮度增加,无肺纹理,肺向透亮度增加,无肺纹理,肺向肺
13、门萎缩,密度增高,其边缘肺门萎缩,密度增高,其边缘可见发线样脏层胸膜阴影;可见发线样脏层胸膜阴影;n健侧肺可有代偿性肺气肿,肺健侧肺可有代偿性肺气肿,肺纹理增粗;纹理增粗;n气管与纵隔可向健侧移位;气管与纵隔可向健侧移位;n并发胸水或血液时,可见到液并发胸水或血液时,可见到液平面。平面。12Auxiliary examinationn n2.CT Is more sensitive to 2.CT Is more sensitive to the diagnosis of a small the diagnosis of a small amount of gas in the amount
14、of gas in the pleural cavitypleural cavityn nClearly shows a small Clearly shows a small amount of pneumothorax amount of pneumothorax and lung tissue and lung tissue overlapping parts of the overlapping parts of the pneumothorax;pneumothorax;n nLocation,extent determine Location,extent determine th
15、e pleural product gas;the pleural product gas;n nMay found emphysema May found emphysema blister;blister;n nEasy to identify the Easy to identify the limitations of limitations of pneumothorax and lung pneumothorax and lung bullae.bullae.n2.CT 对胸腔内少量气体的对胸腔内少量气体的诊断较为敏感诊断较为敏感n可可清清晰晰地地显显示示少少量量气气胸胸和和与与肺
16、肺组织重叠部位的气胸;组织重叠部位的气胸;n确定胸腔积气的位置、程度;确定胸腔积气的位置、程度;n有可能发现肺气肿疱;有可能发现肺气肿疱;n易于鉴别局限性气胸和肺大疱。易于鉴别局限性气胸和肺大疱。133.Pleural cavity angiographynThis method can clear the pleural surface,easy to clear the cause of pneumothorax.When the lung compression area in 30%40%when the contrast is appropriate,bulla is lobe pr
17、ofile within a single or multiple cystic low density shadow;a bubble spray performance for pleural phenomenon,especially when patients with cough,due to intrapulmonary pressure increases,this phenomenon is more obvious.n此方法可以明了胸膜此方法可以明了胸膜表面的情况,易于明表面的情况,易于明确气胸的病因。当肺确气胸的病因。当肺压缩面积在压缩面积在30%40%时行造影为宜,时行造
18、影为宜,肺大泡表现为肺叶轮肺大泡表现为肺叶轮廓之内单个或多个囊廓之内单个或多个囊状低密度影;胸膜裂状低密度影;胸膜裂口表现为冒泡喷雾现口表现为冒泡喷雾现象,特别是当患者咳象,特别是当患者咳嗽时,由于肺内压增嗽时,由于肺内压增高,此征象更为明显。高,此征象更为明显。144.ThoracoscopicnThoracoscopy can easily detect pneumothorax etiology,flexible operation,can reach the interlobar fissure,apex,hilar,almost no blind spots,observe the
19、visceral pleura with no rips,pleura without bullae of lung and chest cavity with no adhesive joint.n胸腔镜可以较容易地发胸腔镜可以较容易地发现气胸的病因,操作灵现气胸的病因,操作灵活,可达叶间裂、肺尖、活,可达叶间裂、肺尖、肺门,几乎没有盲区,肺门,几乎没有盲区,观察脏层胸膜有无裂口、观察脏层胸膜有无裂口、胸膜下有无肺大泡及胸胸膜下有无肺大泡及胸腔内有无粘连带。腔内有无粘连带。15 Principles of treatment 治疗原则治疗原则16Principles of treatment
20、1.Conservative treatment2.Exhaust treatment3.Operation treatment17 1.Conservative treatment Mainly applicable to the Mainly applicable to the stability of a small amount of stability of a small amount of closed pneumothoraxclosed pneumothorax Specific methods:strict Specific methods:strict bedresana
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