急性腹膜炎课件

直接扩散:泌尿系感染，细菌通过腹膜扩散至腹腔。
透壁性感染:肠内细菌通过肠壁进入腹腔，见于肝硬 化腹水、肾病、猩红热、营养不良等。
2022/3/23
1/50Acute Peritonitis
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With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
解剖生理概要
➢ 腹膜：一层很薄的浆膜，分壁腹膜和脏腹膜。 腹膜几乎与全身皮肤面积相等，约1.7～2.0m2 。 腹膜是双向半透膜:水、电解质 、尿素及 小分子物
质可透过。 脏层腹膜固定于内平大脏卧腹，时腔形小，成腹因网腔此膜后腹、上膜肠部炎系及或膜膈手及下术韧位后带置病。低人 ➢ 腹膜腔：壁层取和半脏卧层位腹，膜可之避间免的大潜腹在腔腔的隙脓。液存于 腹膜腔是人体膈最下大区的或浆流膜入腔小。腹腔形成脓肿。
2022/3/23
1/50Acute Peritonitis
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With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
病因
➢ 继发性腹膜炎(secondary peritonitis):腹内有原发性病 灶，如脏器炎症、穿孔、损伤破裂或手术污染所引起 的腹膜炎。
➢ 继发性腹膜炎病因:
腹内空腔器官穿孔 手术污染
腹腔脏器炎症扩散 开放性腹部损伤
腹前、后壁的严重感染
➢ 主要致病菌:
大肠杆菌最多见，其次厌氧拟杆菌、链球菌、变 形杆等。
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With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
腹部疾病护理
唐山职业技术学院外科教研室 黄秋学
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
临床表现(Clinical
manifestation)
➢ 腹痛:最主要症状。
持续、剧烈腹痛
病灶部位最为显著
深呼吸、咳嗽及体位变换时加剧
➢ 恶心、呕吐: 早期腹膜刺激
脉搏增快＋体温下降
反射性（病胃情内凶容物险）
晚期麻痹性肠梗阻
溢出性(胆汁、粪水样）
➢ 体温、脉搏:早期正常 T升高、 P脉搏增快
小结—继发性腹膜炎病因
➢ 腹腔内炎症:急性阑尾炎、急性胆囊炎发生坏 疽、穿孔，女性生殖器官化脓性炎症，急性胰 腺炎，肝脓肿破裂等。
➢ 空腔脏器穿孔:胃十二指肠溃疡穿孔，肠管损 破裂，肠梗阻所致肠坏死穿孔。
➢ 腹部外伤或手术污染:腹部穿透伤，手术中污 染或消化道吻合口瘘。
➢ 实质性脏器破裂:肝脾破裂。
解剖生理概要
➢ 腹膜的动脉
来自肋间动脉和腹主动脉的分支。
➢ 静脉回腹流前壁腹膜炎时：可引起局部疼痛、压痛和 汇反入射门性静的脉腹及肌下紧腔张静。脉诊。断腹膜炎的主要依据。
➢ 神经支膈配肌: 中心部分的腹膜受到刺激时：通过膈神 壁层经腹的膜反:主射要可受引体起神肩经部(放肋射间性神痛经或和呃腰逆神。经的分支)
多为混合感染，毒性较强。
2022/3/23
1/50Acute Peritonitis
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With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
病因
➢ 原发性腹膜炎(primary peritonitis):腹内无原发性病 灶，细菌经血行、泌尿道或女性生殖器进入腹腔，引 起腹腔感染。常见儿童、老人及肝硬化腹水者。
➢ 细菌进入腹腔途径:
血行播散:肺炎双球菌和链球菌从呼吸道或泌尿道的 感染灶，通过血行播散至腹腔。多见婴儿、儿童。
上行性感染:经女性生殖道进入，如淋菌性腹膜炎。
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With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
解剖生理概要
➢腹膜具有渗出功能：
正常时：腹腔有75~100ml液体 ，起润滑作用。
急性炎症时：大量渗出，既可稀释毒素和减少刺激， 也可引起水电解质平衡失调和低蛋白血症。渗液中 的巨噬细胞能吞噬细菌、异物和破碎组织。
➢发生粘连:
炎性渗液中纤维蛋白沉积在病变周围形成粘连，可 防止感染扩散或修复受损组织，也可引起肠梗阻。
2022/3/23
1/50Acute Peritonitis
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With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
➢ 感染中毒症状:高热、脉快、呼吸浅快、大汗、口干
面色苍白、发绀、脉微弱、血压下降、休克
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With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
急性腹膜炎
Acute Peritonitis
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1/50Acute Peritonitis
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With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
➢腹膜有很强吸收功能:
吸收渗液、血液、空气、毒素等。膈肌腹膜和上腹 部腹膜比盆腔腹膜吸收力强。
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With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
的支配，对各种刺激敏感，痛觉定位准确。
脏层腹膜:受自主神经支配(来自交感N和迷走神经末 梢),对牵引、腔内压力、炎症、膨胀等刺激敏感, 钝 痛而定位差。受刺激心跳慢、BP下降 、肠麻痹。
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1/50Acute ving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
分类
细菌性
原发性
病因
发病机制
非细腹菌膜性炎的分类不是静 继发性
临床过程
止不变的，而是不断
地急变性化着。
局限性
亚急性
范围
弥漫性
慢性
外科临床约98%为急性继发性细菌性腹膜炎
2022/3/23
1/50Acute Peritonitis
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With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society