腹部损伤英文课件

AbdominalInjury,theoutline,theincidenceofabdominalinjuriesinpeacetime:0.4%-1.8%inwartime:50%themortalityofabdominalinjuriesis10%,Typesoftheabdominalinjuries,abdominalinjury,openabdominalinjury,closedabdominalinjury,penetratingabdominalinjury,non-penetratingabdominalinjury,Iatrogenicinjury,Mechanismofclosedinjury,DirectimpactDecelerationandrotationalforcesSpleen,kidney,smallbowelandliverarethemostcommonlyclosedabdominalinjuriedorgans.,Mechanismofopeninjury,StabwoundsGunshotwoundsLiver,smallbowel,stomachandcolonarecommonlyinvolvedintheopenabdominalinjuries.,Theseverityoftheinjuriesandinvolvedorgansdependontheintensity,velocity,positionanddirectionoftheforce.Abdominalanatomicfeaturesandthefunctionsoftheorgansarealsoimportanttotheinjuries.,clinicalmanifestations,abdominalpainhemorrhagicshockperitonitis,abdominalorgansinjuriesaredividedtosolidandholloworgansinjuries.themainmanifestationofthesolidorgansinjuriesishemorrhagethatcanleadtoshock.themainmanifestationoftheholloworgansinjuriesisperitonitis.,Hemorrhageandperitonitiscanexistsimultaneously,whentheinjuriesinvolvethe2kindsofabdominalorgans.,Diagnosis,Accuratediagnosisandmanagementrequiresathoroughhistory,physicalexamination,and,whenindicated,laboratorytests.,whenwediagnosetheinjuryastheopenabdominalinjury,weshouldconsiderifthereisapenetratinginjury.,Diagnosisoftheclosedabdominalinjury,Doestheabdominalorganinjuryexist?Whichorganisinjuried?whethermultipleorgansareinvolvedintheabdominalinjuries?,whenitsstilldifficultytodiagnose,thefollowingmeasurescanbetaken.,auxiliaryexamination,dignosticabdominalparacentesisandperitonealLavage,x-ray,Ultrasound,Abdominalcomputedtomography,MRI,angiography,diagnosticlaparoscopy,observingcloselydeterminethepulserate,respiratoryrate,bloodpressureevery15-30minutes.examinetheabdominalsignsevery30minutes.determinetheerythrocytenumber,hemoglobin,hematocritevery30-60minutes.,exploratorylaparotomy,TheindicationsforlaparotomyAbdominalpainandperitonealirritationsignaggravategradually.Boweltonesbecomesmoreweaker,evendisappeared.Theerythrocytenumberandbloodpressureareinstability.GastrointestinalbleedingRefractoryshock,Managementoftheabdominalinjury,Weshouldidentifyandcorrectanyimmediatelife-threateningconditionsandtreatwiththeotheranticipateproblems.CPRisthemostimportantthinginthecriticalcase.AAirwayBBreathingCCirculationwithhaemorrhagecontrol,Dontsendtheexposedabdominalorgansbacktotheperitonealcavity.CoverthemwithwarmNSsoakedgauze.,Antishocktherapyisakeystepinthetherapeuticprocedure.Ifgivenactiveantishocktherapy,theshockstilldifficultytocorrect,itsuggeststhatthereisprogressiveintraperitonealhemorrhage,theexploratorylaparotomyisnecessary.,Inprinciple,thelaparotomyshouldexploretheabdominalorgansinorderasthefollowing:thesolidorgansdiaphragmastomachduodenumjejunumileummesenterypelvicorgansposteriorsurfaceofstomachpanceas,Splenicrupture,Thespleenremainsthemostcommonlyinjuredorgan.inclosedinjury:20%40%inopeninjury:10%,TheMagnitudeofspleanicrupturedependonpatientage,injurymechanismandpresenceofunderlyingdisease.TheMagnitudeofspleanicrupturedependonpatientage,injurymechanismandpresenceofunderlyingdisease.,Nowspleenisrecognizedasanimportantimmunologicfactory.Theriskofoverwhelmingpostsplenctomyinfection(OPSI)isgreatestinchildlessthan2yrs.RecognitionofOPSIhasstimulatedeffortstoConservespleenbysplenorrhaphy.,TREATMENT,InitialManagementNonoperativeapproach:widelypracticedinpediatrictraumathecriteriafornonoperativeapproachOperativeapproach:Decisiontoperformsplenctomyorsplenorraphyisusuallymadeafterassessment&gradingthesplenicinjury.,Contraindicationforsplenicsalvage:,ThepatienthasprotractedhypotensionUnduedelayisanticipatedinattemptingrepairthespleenThepatienthasothersevereinjury,Liverrupture,Operativemanagement-liver,Gauzepackingmayhaveinfectivecomplications(IvaturyRRetal1986)OmentalpackingResectionaldebridementMassliversutureHepaticarteryligationTotalhepaticisolation-goodforretrohepaticvenousinjuriesAtriocavalshunt,pancreaticinjury,CharacteracuteabdominalpainbecauseofthechemicalperitonitiscausedbypancreaticjuiceAMYinthebloodandurinedifficulttodiagnosebeforethelapartomy,Treatmentkposthesispartialexcisionanddrainage,Gastricinjury,CharacterPeritonitispneumoperitoneumTreatmentkposthesisexcision,Duodenalinjury,CharacternotinjuriedeasilynotnoticedeasilymostlysevereTreatmentkposthesisanastomosisdecompressionanddrainage,Smallintestinerupture,CharacterhighincidenceratePeritonitisisthemainmanifest.pneumoperitoneumTreatmentKposthesisPartialexcisionandanastomosisThebloodvesselsofintestinalmesentericradixshouldbeanastomosed.,Colonrupture,CharacterthethinintestinalwallandthepoorvascularsupplypoorhealingfunctionseriousinfectioneasytomissingdiagnoseTreatmentexteriorizetheintestinalcanalColostomyandKposthesissometimesprimarysuture,