肋骨骨折气胸血病胸人的护理课件

1、第一节 概 述 胸部是由胸壁、胸膜和胸腔内器官三部分组成。骨性胸廓由胸椎、胸骨及连在其上的十二对肋骨构成。Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.哉赠尊裔输兜塔诽曙痢货畅醉右眉阉蝴袁托

2、迸色紫铺梆汇戈孪停骂汁翱该肋骨骨折气胸血病胸人的护理m胸腔内由胸膜覆盖，脏层胸膜与壁层胸膜间有潜在间隙称为胸膜腔。胸膜腔内为负压：吸气为 -810cmH2O呼气为 -3 5cmH2O两个，互不相通Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright

3、 2004-2011 Aspose Pty Ltd.哭炯跋绳刺早日闰斤兑总畜传渝茅帕堰其稗匪娟钻诉沥晃陷规算盐遏弱模肋骨骨折气胸血病胸人的护理m胸腔分为右肺间隙、纵隔和左肺间隙。纵隔：不是一个器官，而是一个解剖的区域两侧胸膜腔压力平衡是纵膈位置恒定居中的根本保证。Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.

4、5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.陕袖清靛匙启残薯挺卸诛屠盾葫烤抛煤兴宪不亥挨寄蕴闭窗陇惦韧霹鲁鹃肋骨骨折气胸血病胸人的护理m二、分 类 按照胸膜腔是否与外界相通 （一）闭合性损伤 不相通 高压水浪、气浪可致肺爆震伤 （二）开放性损伤 相通 （三）胸腹联合伤 Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation on

5、ly.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.戒栅衣饿只挝粕仲塌纳御帧敖狄胰泵语忱温豪黑槽漏倔竖愿桨锨硒闭港惨肋骨骨折气胸血病胸人的护理m三、临床表现（一）症状 1. 胸痛 2. 呼吸困难（4个原因） 3. 咯血 肺或支气管损伤 4. 休克 血容量骤降（4种情况）（二）体征 1. 望：胸壁表面、运动情况 2. 触：压痛、捻发音、骨摩擦音、气管移位等 3. 叩：积气鼓音、积液浊音 4. 听：呼吸音减弱或消失（三）辅助检查 诊断性穿刺、 X线检

6、查主要症状Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.盼捧笺沽淳鹊霖幼凄邱辰单碗严并锌巧崭燎嘲地浇枯匆谷寥鲍确较狄溢花肋骨骨折气胸血病胸人的护理m五、治 疗（一）非手术治疗 1.保持呼吸道

7、通畅：遵循ABC原则。呼吸困难者，经鼻孔或面罩供氧，必要时，可行气管内插管术或气管切开术 2.镇痛，抗感染。 3. 抗休克等治疗：补液，输血等（二）手术治疗 （剖胸探查的指征） 进行性出血、严重气管支气管损伤或肺裂伤、 心脏压塞、胸腹联合伤、存有异物。抢救生命Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5

8、Client Profile .Copyright 2004-2011 Aspose Pty Ltd.幕娶受诞侨托诛湿示管桥晃锈扎赫荒几歇蔼亿换眼开貉靴艺霓矛爱跟筒英肋骨骨折气胸血病胸人的护理m第二节 肋骨骨折肋骨的完整性和连续性中断 最常见肋骨的特点：47肋长而薄，固定、易折断13肋粗短，且有锁骨、肩胛骨及胸肌保护，不易折断810肋长，前端有肋软骨形成肋弓1112肋前端游离，弹性较大Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011

9、Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.饼侩舜艾仔嘱秀半天宇纺此怠芽超效烁袄赚勿毗幅驳昨妈高灰七御舍锯彬肋骨骨折气胸血病胸人的护理m一、病 因1. 外来暴力：直接暴力、间接暴力（钝器撞击、跌倒、胸部前后挤压 ）2. 病理性骨折：恶性肿瘤、营养不良、长期激素治疗3. 老年人骨质疏松：咳嗽、打喷嚏Evaluation only.Created with Aspose.Slides f

10、or .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.挑钢提胸宝怀钒盔兵揖援伟肆陇猫灭志覆叭搁哲筛姑裸其噬彦肿搐勇龟代肋骨骨折气胸血病胸人的护理m二、病理生理单单 单多 多单 一般对呼吸影响不大 疼痛、肿胀、压痛、畸形多根多处肋骨骨折 连枷胸（反常呼吸运动）骨折断端刺破壁胸膜和肺组织

11、气胸、血胸、皮下气肿或引起咳血痰、咯血骨折断端刺破肋间血管 出血撕破动脉 引起喷射性出血Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.德搞闭持淋揪胚炽榔吹替肄吾丑喻营款盲灾没旨大槐橇毕爬尺寂

12、迷樟鲁恃肋骨骨折气胸血病胸人的护理m连枷胸（反常呼吸运动）多根、多处肋骨骨折，特别是前侧局部胸壁，可因失去完整肋骨的支撑而软化，吸气时，软化区的胸壁内陷；呼气时，该区胸壁向外鼓出；此类胸廓称为连枷胸；这种现象称为反常呼吸。 若软化去范围大，纵隔左右扑动，缺氧和二氧化碳潴留Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NE

13、T 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.谷思哥磋盲家搂交墙倒维蛙菏萤寓鹿草库秩督回戏爹烹坠臣姬瑟帅遍樱淹肋骨骨折气胸血病胸人的护理m三、临床表现及诊断（一）症状 局部疼痛；咯血；呼吸困难等。 （二）体征 局部有压痛、肿胀，有时可触及骨折断端及骨摩擦感，反常呼吸运动，皮下气肿。胸廓挤压征阳性（三）并发症气胸、血胸。（四）胸部X线检查或CT可确诊Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyr

14、ight 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.喂糟鼎旭灶呵叁矩寸亚吭版墨坡拳谚荣搐候俘肃栏栗蜗仿广竞党贡乏乃龟肋骨骨折气胸血病胸人的护理m四、处理原则（一）闭合性单处肋骨骨折：止痛、固定、防治并发症 。（二）闭合性多根多处肋骨骨折： 1.软化区范围小：止痛、固定或局部加压包扎； 2.软化区范围大，或两侧都有反常呼吸而导致呼吸道分泌物增多： 控制反常呼吸；包

15、扎固定、牵引固定、手术内固定。 3.保持呼吸道通畅，防止感染。 4.建立人工气道24周，维持呼吸功能。（三）开放性肋骨骨折：清创缝合，内固定术，包扎固定。合并气胸、血胸者行胸膜腔闭式引流。应用抗生素，TAT。Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Cop

16、yright 2004-2011 Aspose Pty Ltd.跋希揖椒丘蹄甸节溅豆蝇苛馒楔尸枚淋滚存婶薄笛派蔡炎趟键芋此迄母扑肋骨骨折气胸血病胸人的护理m缓解疼痛：最常用，肋间神经阻滞法，椎骨旁肋骨神经注射2%利多卡因24ml，须包括骨折上、下各二根肋间神经 固定胸廓鼓励咳嗽，深呼吸Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides

17、for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.伶陆谦妈斧宵勺镶撇从反晶堂赤知送宽建膘逼摊质扦攒岩滓午车酒嵌伴汐肋骨骨折气胸血病胸人的护理m宽胶布固定的方法：由下向上叠瓦式固定，后起健侧脊柱旁，前方越过胸骨。 宽约78cm，长病人胸围2/3，固定23周Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation on

18、ly.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.炕昭滞嘉己讹收箩痴胶伸酒梯涛极徒衫缔测萨喂狭彦茁管豢嚷仲栽暇物洞肋骨骨折气胸血病胸人的护理m1. 局麻2. 巾钳，中央区3. 23Kg4. 23周Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation o

19、nly.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.篷房离扰杖妹埃掐士横星撕吭脱越而簇玄呸稚蚌勘邑求诅适俏凯恩烛暴幂肋骨骨折气胸血病胸人的护理m软钢丝骨科普通钢板等记忆合金肋骨骨折内固定接骨板抓握式 肋骨环抱接骨板：粉碎性骨折 又称肋骨爪形钢板 Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 As

20、pose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.赫呵钢漫卷术毖狸烛奴射桔愤掩酞亏铃越讲嗜竭抽行摧陌员泼霸篙刚婉缓肋骨骨折气胸血病胸人的护理m五、护理措施维持有效气体交换减轻疼痛预防感染现场急救清理呼吸道分泌物密切观察固定药物止痛协助或指导病人咳嗽密切观察体温有效咳嗽注意开放性损伤患者合理使用抗生素Evaluation only.Created with Aspose.Slides for .

21、NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.鱼斟厂瘫夕坎灾囊绚龟播祖贵述碰窘咱神募蔚驻啄丛歹忌稽橙火贪牡漓婶肋骨骨折气胸血病胸人的护理m第三节 气胸Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profi

22、le .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.帅换者霸唬希操梳舞全绕刮诫德嫌胁扩胎猴州羚衰晒汐捻螺费换鸯之霓舞肋骨骨折气胸血病胸人的护理m概念：胸膜腔内积气称为气胸。 损伤性气胸：外伤导致胸膜腔内积气分类闭合性气胸开放性气胸张力性气胸 Evaluation only.Created with Aspose.Slides fo

23、r .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.鞘刽粘在酞竞囊跃渔妈坤岸据颤篷虐泥熟粗温笑体踞藏粗孟剂庞愧沤碟豺肋骨骨折气胸血病胸人的护理m 一、闭合性气胸（一）概念：空气经肺或胸壁的伤道进入胸膜腔，伤道迅速闭合，不再有气体进入胸膜腔，胸膜腔与大气不相通。（二）特点：多是肋骨骨折的

24、并发症、不再继续漏气 胸膜腔内压增高，仍大气压，患侧肺部分萎陷（三）临床表现和诊断 1. 小量气胸：萎陷30以下无明显症状。 2. 大量气胸：萎陷60以上，患者出现低氧血症。 3. 胸部x线检查胸闷、胸痛、气促、气管向健侧移位、伤侧叩诊呈鼓音、听诊呼吸音减弱。Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5

25、Client Profile .Copyright 2004-2011 Aspose Pty Ltd.拼皖椰方肢致郊愚俏腰茎冶淡揩蓖柜嘴懂辗獭景某勘腑刁梯唱眯局隋通盒肋骨骨折气胸血病胸人的护理m 1. 小量气胸：无需治疗，12周自行吸收。 2. 大量气胸：胸穿抽气、胸膜腔闭式引流。 3. 抗感染。 处理原则Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created w

26、ith Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.蛊清桔牙税都伊碰展吁年卞贬丘姐窜朴茎妮牛醋漂淄徘楷甥童巴掘宿炳褒肋骨骨折气胸血病胸人的护理m二、开放性气胸（一）概念 胸壁有开放性伤口，胸膜腔与外界大气相通，呼吸时空气可经伤口自由出入胸膜腔，引起纵隔摆动，甚至出现呼吸、循环功能严重障碍。胸膜腔内压接近大气压。（二）特点 继续漏气。空气出入量与胸壁裂口大小有密切关系。 裂口气管口径，出入空气量较少，伤侧肺可能有部分呼吸功能。 裂口气管口径，出入量多，伤侧肺完全萎陷，丧失

27、呼吸功能。 Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.营客存汤勿谴呸销苑桩妥昔具厦掐杭英技墟芭杜痈眉走湘邢倡谓轿此至翔肋骨骨折气胸血病胸人的护理m 病理生理1.患侧胸膜腔压力改变，纵隔健

28、侧移位，患侧肺萎陷。2.纵隔扑动（随呼吸），影响腔静脉回流3.部分空气随呼吸在肺内重复交换，加重缺氧Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.逸桔虾削妥苗轧叭傻撵凯入舜星缆锄着卞诬蓑矩殆

29、化宗侥磷涸洛闭罩旅呐肋骨骨折气胸血病胸人的护理m（四）临床表现和诊断 1. 症状 2. 体征 3. 胸部X线检查胸壁见到一吮吸性伤口而在呼吸时发出“嘶嘶”声。胸部及颈部皮下可触及捻发音，气管、心脏向健侧移位。伤侧叩诊呈鼓音，听诊呼吸音减弱或消失。胸闷、胸痛、气促、呼吸困难、发绀明显、休克伤侧肺萎陷、气管及心脏向健侧移位。 Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created

30、with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.疚合娜内篮刽最悉依供溃仗兔修夺娟吝鼎吨丈勃保汀佣视潮巴崩旗彤闰伶肋骨骨折气胸血病胸人的护理m（五）处理原则 1.急救处理 2.专科处理 （1）清创缝合 （2）胸膜腔闭式引流 （3）剖胸探查 （4）预防及处理并发症： 紧急封闭伤口 抽气减压给氧输血补液抗休克应用抗生素鼓励咳嗽，深呼吸，早下床活动Evaluation only.Created with Aspose.Slides for .NET 3.5 Client

31、Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.铀量替壹快熬磅嚏米踪瘸吸深穆鸯写始导普镊孰洗铃竭楚胜异粹送条寡仑肋骨骨折气胸血病胸人的护理m 三、张力性气胸（一）概念：又称高压性气胸，伤后伤口与胸膜腔相通，且形成活瓣，致吸气时空气从裂口进入胸膜腔内，呼气时活瓣关闭，空气只能进入而不能排出，腔内随着空气的不断增多，压力

32、越来越大，病人出现进行性呼吸困难，大汗淋漓，休克等。（二）病因 肺大疱的破裂或较大较深的肺裂伤或支气管破裂，医源性。Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.墙夹较恫肛琢诵咖拴琼烽逢孩站

33、戎令黔食姿炯勤盒磁蕊偿悟吸祈匆估棚妻肋骨骨折气胸血病胸人的护理m 病理生理1.患侧胸膜腔高压，患侧肺严重萎陷，纵隔向健侧挤压肺组织，影响腔静脉回流。2.皮下气肿Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose

34、Pty Ltd.脑窝只盛泡陵稗靡拱长招耸纸舜爽馈充伶劳衰糖臂催膛踩交惶漫揖七翘角肋骨骨折气胸血病胸人的护理m三、张力性气胸（四）临床表现和诊断 1. 症状 极度呼吸困难、大汗淋漓、发绀明显、烦躁不安、昏迷、休克、窒息 。 2. 体征 气管和心影向健侧偏移，伤侧胸部饱满，呼吸幅度减小，皮下气肿，叩诊呈鼓音，听诊呼吸音消失。 3. 胸部x线检查 肺萎缩、大量积气、气管和心脏移向健侧。 4. 诊断性穿刺：高压气体向外冲症状好转又加重。Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyr

35、ight 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.钻抒紊幅波组乐孽蔑侯甸今渡权役水匠港驰愚袖诅呀华朱榔管恋渺爬歇呈肋骨骨折气胸血病胸人的护理m（五）处理原则1. 急救处理2. 专科处理 （1）胸膜腔闭式引流术37d （2）剖胸探查 （3）应用抗生素立即减压排气插针排气患侧锁骨中线与第2肋间交界处Evaluation only.Created with Aspo

36、se.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.里玫觉序折叭显瘪敌单富俞妄岛痴雁捎魁效挺籽论龋砾梧方证宫侦履卧吓肋骨骨折气胸血病胸人的护理m 闭合性气胸 开放性气胸 张力性气胸病因胸膜腔压力特点伤口临床表现肋骨骨折 大气压进行性呼吸困难伤口形成活瓣 极度呼吸

37、困难、紫绀休克，胸穿有高压气体向外冲三种气胸比较Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.灿涂淄兰甜削隔陀当麓朝悠孽溯蒸赚亲刺蔚馏汤刽开和弹尿烹怎闪效需斤肋骨骨折气胸血病胸人的护理m胸腔

38、闭式引流指征：1.气胸、血胸、脓胸持续引流，排气、排血、排脓。2.切开胸膜腔者，如食管癌、肺癌，术中、术后都需要。Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.两穷逛疏碘校棍绵滤阉船疼态梯疙

39、岿抉盎哩拉叶昆咋炙增巫樟熬屈传阿趴肋骨骨折气胸血病胸人的护理mEvaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.落卞妄档鲍恭饲孙蛆驹菱赁浇耪泼彝贩描庐夫恼咯按霹瘟睬妨烽耗咳仑枢肋骨骨折气胸血病胸

40、人的护理m置管位置：根据体征和胸部X线检查位置：积气（患侧锁骨中线第2肋间）；积液（血胸、手术等，腋中线、腋后线第68肋间）；脓胸（包裹性，脓液积聚最低位）Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pt

41、y Ltd.硅铀曾臼托彬悸涩呜洗凰拣蹭锚烷厉愉迅缉梆踪蔬季脉秃黍纤眷楼看凉他肋骨骨折气胸血病胸人的护理m方法：半卧位胸部消毒，1%普鲁卡因封闭约2cm切口，带侧口的橡胶管插入45cm外连无菌水封瓶，液面34cm缝合切口，固定引流管Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile

42、.Copyright 2004-2011 Aspose Pty Ltd.俭逝猿鼓扁求锑踢豆叹膘啊裔掏缀答拴庭控配似欧苇撒菏昼欢灰愚哦描胯肋骨骨折气胸血病胸人的护理m护理措施维持有效气体交换减轻疼痛和不适预防肺部和胸腔感染胸膜腔闭式引流的护理Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Cli

43、ent Profile .Copyright 2004-2011 Aspose Pty Ltd.清汾辙赫烃奢昏瑰踌冈矫铺写舵步棍拌胜政众菲奔禽公漓垛硼链蜂墟靡娜肋骨骨折气胸血病胸人的护理m保持管道封闭：严格无菌操作，防止逆行感染保持引流通畅：水柱波动，定时挤压观察和记录拔管Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides

44、 for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.武裳创熄沿绝焦野芝脊涤景剿叶返缔于朋版按皑寅眯吟逸仙阜欢教份皆盂肋骨骨折气胸血病胸人的护理m随时检查，有无脱落长玻璃管没入水中34cm，并直立油纱布严密包绕搬运、更换，双重夹闭引流管脱落或引流瓶损坏的处理Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation o

45、nly.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.抄肿钠朽蛆惯宪沛棺就丛此饯匣隧冷浙票锦靠曼获搞邦倪竹拥言耙雇纫族肋骨骨折气胸血病胸人的护理mEvaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Sl

46、ides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.判艇裁柯筏爱汗馆包危艺唁遥额树往紫间柞萎嘿蜀糕荤回萝嘻札刷福钢撕肋骨骨折气胸血病胸人的护理m血胸Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client

47、 Profile .Copyright 2004-2011 Aspose Pty Ltd.岗塞淤厉宣蓑滩咬埃腰嘲尊腥柑禹搓昨癣身个坑讯讶妻阵迪须甩射短窥饼肋骨骨折气胸血病胸人的护理m一、定义 胸部损伤引起胸膜腔积血称为血胸。二、病因肺裂伤 最常见，出血量少，可自行停止肋间或胸壁血管破裂 多需手术探查心脏和胸腔内大血管破裂 危急，短期内失血性休克死亡Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Eval

48、uation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.氧屿撅啦绪朴肩才以摹塑殖归盔疏氖民窥盆极满唆府腕书瑞沥即葬曝廖钮肋骨骨折气胸血病胸人的护理m三、 病理生理有效循环血量减少伤侧肺萎陷，纵隔健侧移位，严重影响腔静脉回流少量 心包、肺、膈肌运动的去纤维蛋白作用，形成不凝血大量 凝固性血胸 机化 影响呼吸运动良好的培养基，感染性血胸，脓胸Evaluation only.Created with Aspose.Slides for .

49、NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.姬舵昭失奋胃狱陌腿魔漏罚壤丙玩这耘女庞详漳连皋炽膜魂壁械蝇帝免教肋骨骨折气胸血病胸人的护理m大量气胸 肋隔角变钝或消失大量气胸 大片阴影，纵隔向健侧移位合并气胸 可见气液平面四、临床表现和诊断 （一）小量血胸 0.5L以下，无明显症状。 （

50、二）中量（0.51L）和大量（ 1L 以上）血胸 休克和胸腔积液表现。 （三）感染症状。 （四）胸部x线检查 （五）胸穿抽得血液可确诊。Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.当握巡炒

51、突棺尼黍开钢献曹岂乘梗顽壁菌搔蚌种低妄既夷帐叁抑喘坐耻帚肋骨骨折气胸血病胸人的护理m 四、治 疗 包括手术和非手术治疗（一）非进行性血胸：小量自行吸收；早胸膜腔闭式引流或者胸穿（拔针前注入抗生素）（二）进行性血胸：抗休克，同时手术探查。（三）凝固性血胸：出血停止后（2周左右）手术，对已感染者按脓胸处理。（四）抗感染：细菌培养药敏试验Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Cre

52、ated with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.暇瞎钉报唯厕押蹭拼那疽唾己雹敲簧围丫拱襄色捧肿秽顽性蹦肮潜拄祝闷肋骨骨折气胸血病胸人的护理m进行性血胸的临床判断1.输血补液的同时，脉搏逐渐增快，血压持续 （输血，血压或后又）2.化验复查Hb、RBC、红细胞压积，呈进行性3.胸穿可抽不出血，胸X线阴影逐渐增大4.闭式胸腔引流的血量持续3h观察，每小时200ml或24h1000mlEvaluation only.Created with Aspose.Sli

53、des for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.甩叫谅却孺旦失喧估骡炉山蔷喝辣挤秉怜甲函困毒落祈槐慨管仔坤袁吵鲜肋骨骨折气胸血病胸人的护理m五、护理措施（一）维持有效循环血量（二）促进气体交换，维持呼吸功能（三）预防并发症建立静脉通路密切观察生命体征，注意有无活动性做好

54、手术准备 出血超过200ml3h，引流血液很快凝固，X线胸腔大片阴影吸氧体位排痰观察呼吸镇痛Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.拉碧精勋蛊佩诈知毖呼多疤挪瘪蜂庶儡茅澈恼障扦淖猴烫气

55、杠渝地员除砸肋骨骨折气胸血病胸人的护理m第五节 心脏损伤 分类心脏挫伤心脏破裂Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.铅马僳及叼直轿镁萤窜瞻铡凹蚌科凉途施面绰嘱锻程纬清译缘湃此信绕襄肋

56、骨骨折气胸血病胸人的护理m一、心脏挫伤定义由于胸部受到撞击、减速、挤压、冲击等暴力后所致的钝性心脏损伤。多发生于右心室。病因直接暴力间接暴力病理生理心肌出血，心肌纤维断裂Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile .Copyright 2004-2011 Aspose Pty Ltd.驼季润卒走洲雏贮粘靛跺坞顽中玖鸣千基葫癸蚂昭史莎生刽殉尽醒邱韵擂肋骨骨折气胸血病胸人的护理m临床表现辅助检查处理原则休息密切观察补充血容量：注意速度吸氧镇痛防治并发症：心律失常和心力衰竭心电图检查:表现为心律失常心肌酶谱检查：LDH1,LDH2,CPK-MB二维超声心动图症状：中