影像科容易忽略的病：膀胱输尿管反流课件

影像科容易忽略的病：膀胱输尿管反流ppt课件汇报人：xxx20xx-03-162023-2026ONEKEEPVIEWREPORTINGlogologologologoWENKUCATALOGUE膀胱输尿管反流概述影像学检查方法在诊断中应用影像表现与解读技巧治疗方案选择及适应证评估总结回顾与展望未来进展方向目录膀胱输尿管反流概述PART01膀胱输尿管反流（VUR）是指排尿时尿液从膀胱反流至输尿管和肾盂的现象。定义与膀胱输尿管连接处解剖结构异常、膀胱内压增高、输尿管口括约肌功能异常等因素有关。发病机制定义与发病机制VUR在小儿中较为常见，但也可持续到成年。反流性肾病（RN）是VUR的重要并发症之一。包括先天性尿路畸形、尿路感染、神经性膀胱等。流行病学及危险因素危险因素流行病学以下附赠各项管理制度英文版（不需要可删）急救药品、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.护理文书书写制度:

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.患者可出现尿频、尿急、尿痛等膀胱刺激症状，以及发热、腰痛等全身症状。严重者可导致肾积水、肾功能损害等。临床表现根据反流程度可分为五级，从I级（轻度反流）到V级（重度反流）。分型临床表现与分型诊断标准结合临床表现、尿常规、尿培养、影像学检查等结果进行诊断。其中，排尿性膀胱尿道造影（VCUG）是诊断VUR的金标准。鉴别诊断需与尿路感染、尿路结石、肾结核等疾病进行鉴别。诊断标准及鉴别诊断影像学检查方法在诊断中应用PART02超声检查无创、无辐射、可重复性好，适用于各年龄段患者。患者需憋尿，使膀胱充盈，有利于观察输尿管和膀胱。多角度、多切面扫查，注意观察输尿管开口及喷尿情况。受肠气、体型等因素影响，对轻度反流可能漏诊。优点检查前准备检查技巧局限性原理优点检查前准备注意事项排泄性尿路造影01020304通过静脉注射造影剂，观察造影剂在尿路中的排泄情况。可显示尿路形态和功能，对反流程度分级有重要价值。患者需清洁肠道，减少粪便对图像的干扰。对造影剂过敏者禁用，肾功能不全者慎用。原理优点适用范围局限性核磁共振水成像技术利用核磁共振原理，获取水分子在尿路中的分布图像。适用于各种年龄段患者，尤其适用于造影剂过敏者。无辐射、无需注射造影剂，对肾功能无影响。价格昂贵，检查时间较长，对幽闭恐惧症患者可能不适用。123利用CT技术观察尿路形态和功能，对反流诊断有一定价值，但价格昂贵且辐射较大。CT尿路成像通过静脉注射放射性核素标记物，观察其在尿路中的排泄情况，对反流诊断有辅助作用，但存在放射性污染风险。放射性核素检查直接观察膀胱内部情况，对反流诊断有确诊价值，但属于有创检查且并发症风险较高。膀胱镜检查其他影像学检查方法影像表现与解读技巧PART0303输尿管壁增厚、毛糙长期反流可导致输尿管壁增厚、毛糙，为慢性炎症表现。01膀胱充盈时输尿管扩张在膀胱充盈期，可见输尿管扩张，提示尿液从膀胱反流至输尿管。02肾盂肾盏扩张积水反流严重时，可见肾盂肾盏扩张积水，表明尿液已反流至肾脏。典型影像表现分析轻度反流时，影像表现可能不明显，易被忽略。轻度反流输尿管开口异位合并其他畸形部分病例输尿管开口异位，导致反流易被误诊或漏诊。膀胱输尿管反流可能合并其他泌尿系畸形，如肾发育不良、重复肾等，需注意鉴别诊断。030201容易被忽略的影像特征与正常生理现象的鉴别01婴幼儿期输尿管轻度扩张可视为正常现象，需与病理性反流相鉴别。与其他泌尿系梗阻性疾病的鉴别02如肾盂输尿管连接处梗阻、膀胱颈梗阻等，需结合病史、临床表现及影像学检查进行鉴别。与泌尿系感染的鉴别03反流可导致泌尿系感染，但感染并非一定由反流引起，需结合尿流动力学检查进行鉴别。鉴别诊断要点提示病例分享与讨论病例一分享一例典型膀胱输尿管反流病例，包括患者基本信息、临床表现、影像学检查及诊断过程，重点讨论影像表现与鉴别诊断思路。病例二分享一例易被忽略的轻度反流病例，讨论其影像特征及漏诊原因，提高对该类病例的认识和诊断水平。病例三分享一例合并其他畸形的膀胱输尿管反流病例，讨论其诊断及治疗过程中的经验教训，为临床提供参考。治疗方案选择及适应证评估PART04使用抗生素控制感染，减轻症状。药物治疗避免过度劳累，保持大便通畅，减少腹压增高的因素。生活方式调整对于轻度反流且无并发症的患者，可选择定期随访观察病情变化。定期随访保守治疗措施介绍手术适应证包括中重度反流、保守治疗无效、反复发作的泌尿系感染、肾功能损害等。术式选择根据患者年龄、反流程度、肾功能等因素，可选择输尿管膀胱再植术、膀胱扩大术等。手术