外科期末复习

目录

第一章总论1

第二章头颈部9

第三章胸部肺部心脏及乳房12

第四章胃肠道16

第五章腹部疾病22

第六章消化腺疾病26

第七章血管外科疾病33

第八章泌尿及男生殖系统35

第九章骨折及关节疾病39

第十章骨与关节化脓性感染、结核及肿瘤43

第十一章运动系统的慢性损伤44

第一章总论：外科休克、水电解质酸碱、器官功能不全与衰竭、重症监测治

疗与心肺脑复苏、麻醉

名解

1、=休克shock-一Aclinicalsyndromeresultsfrom团decreaseofeffectivecirculatorybloodvolume,

inadequatetissuereperfusionwhichsubsequentlyleadstocellularanoxia,metabolicdisturbance

anddysfunction.

2、二低血容量休克HypovolemicShock-isastateofdecreasedeffectivecirculatoryblood

volume,causedbylargeamountofbloodorbodyfluidloss,inflammatoryexudation,orbody

fluidaccumulatedinthecavity.

3、外科休克surgicalShock一①Hypovolemicshock(hemorrhagicshock,traumaticshock)②

Distributiveshock(septicshock,neurogenicshock,allergicshock)③Cardiacshock④Obstructive

shocko

4、■脊髓休克spinalshock一当脊髓与高位中枢断离时,脊髓暂时丧失反射活动的能力而进

入无反应状态的现象称为脊髓休克。

5、1氐渗性缺水Hypotonicdehydration-Losin^morenatriumthanwateratthesametime,

resultinginECFdeficitandhyponatremia.

6、■等渗性缺水isotonicdehydration—Losingnatriumandwaterproportionally,theserum

natriumlevelisnormal,osmoticpressureofECFcanremainnormal.

7>-MODS—Multipleorgandysfunctionsyndrome(MODS)isthepresenceofalteredorgan

functioninacutelyillpatients.Itusuallyinvolvestwoormoreorgansystems.

8>-SIRS—SystemicInflammatoryResponseSyndrome,Manifestedbytwoormoreofthe

followingconditions:①Temperature〉38℃or<36℃©Heartrate>90beats/min@Respiratory

rate>20beats/minorPaCO2<32mmHg④WBCcount>12,000/mm3,<4,000/mm3,or>10%

immature(band)formSo

9>ARDS—referstothesyndromeoflunginjurycharacterizedbydyspnea,severehypoxemia,

decreasedlungcompliance,anddiffusebilateralpulmonaryinfiltrateso

10、急性肾衰Acuterenalfailure(ARF)-Asyndromecharacterizedbyarapiddecreaseinthe

abilityofkidneytoeliminatewasteproducts,Clinicallymanifestedbydecreasedurineoutput

andtheaccumulationofthewasteproductsofthemetabolismofnitrogen(ureaandcreatinine)。

11、;肺，心脑复苏CardiopulmonarvResuscitation(CPR)-isanemergencyprocedurewhichis

performedinanefforttomanuallypreserveintactbrainfunctionuntilfurthermeasuresare

takentorestorespontaneousbloodcirculationandbreathinginapersonincardiacarresto

12、Intensivecareunit(ICU)-isaspeciallystaffedandequippedhospitalwarddedicatedtothe

managementofpatientswithlife-threateningillnessesjnjuriesorcomplications

13、低氧血Hypoxemiaisdefinedasdecreasedpartialpressureofoxygeninblood,aslessthan

60mmHg(8.0kPa)

14、Oxygentherapyistheadministrationofoxygenasamedicalintervention,byincreasingthe

FiO2(吸入氧浓度)andPAO2(吸入氧分压),inordertoincreasethePa02(动脉血氧分压)

andeaseorevenrectifythehypoxemia

15、MechanicalVentHation机械通气一isamethodtomechanicallyassistorreplace

spontaneousbreathing.Includingendotrachealintubation(气管插管)&tracheostomy(气管切

开)

16、心脏骤停Cardiacarrest-isthecessationofnormalcirculationofthebloodduetofailureof

thehearttocontracteffectivelyduringsystole.

17、麻醉Anesthesia-Themanagementofproceduresforrenderingapatientinsensibletopain

andemotionalstressduringsurgical,obstetrical,andcertainmedicalprocedures.

18、generalanesthesia全麻--Anestheticgetintothebodythroughrespiratorytract、veinor

intramuscularinjection,resultinginthedepressionofCNS.clinicalmanifestationsarelossof

consciousnessandpain,forgottenreflectiondepressionandcertaindegreeofmusclesrelax.The

depressionistotallyreversibleandwhentheAnestheticisetabolizedorexcreted,thepatientwill

beconsciousgradually.

19、最小肺泡浓度MAC(minimumalveolarconcentration)…Theequilibriumend-tidal

anestheticconcentrationthatpreventmovementinresponsetosurgicalskinincisionin50%of

humansubjects.

简答

1、二感染性休克的治疗原贝1Treatmentofsepticshock/principlesofsepsisshocktreatment/

休克治疗--①FluidreplacementorBloodtransfusiontoincreaseBloodvolume②controlthe

infection:Antibioticsandoperation③Treatacidosis@Vasoactivedrugs⑤Dexamethasone⑥

①迅速补充

Nutrientssupplyetc©preventDICandMODS@Maintainingvitalorgan'sfunctiono

血容量；②控制感染：处理原发感染灶；应用抗菌药物；改善病人一般情况，增强抵抗力。

③纠正电解质和酸碱平衡紊乱；④改善微循环，应用血管活性药；⑤应用糖皮质激素；⑥监

测重要脏器如心脑肾功能，防治DIC和MODSo

2、感染性休克的临床表现Clinicalmanifestationofsepticshock—Coldshock///Heatshock：

©Consciousness：agitated,apathy///awaken；②Skincolor：pallor;cyanosis///pink；③Skin

temp.：wetandcold///dryandwarm；©Capillaryreperfusiontime：prolonged///l~2sec；

⑤Pulse：fastandfeeble//slow,clear/；@BPgap(mmHg)：<30///>30；⑦Urineoutput(per

hour)：<25mL///>30mLo

SignsColdshockHeatshock

Consciousnessagitated,apathyawaken

Skincolorpallor,cyanosispink

Skintemp.wetandcolddryandwarm

Capillaryreperfusiontimeprolonged1~2sec

Pulsefastandfeebleslow,clear

BPgap(mmHg)<30>30

Urineoutput(perhour)<25mL>30mL

3、休克的治疗HowisShocktherapy—(1)EarlyGoalDirectiveTheranv：①MAP265mmHg

②UieOtt205l/k/h②UrineOutput>0.5ml/kg/hr(3)CVP8-12mmHg(4)SvQ2^70%；(2)

Treatment：©Emergenttherapy：Controlbloodloss>Ensureairway>Centralline^02supply、

Keepwarm>Analgesia；②Bloodvolumeresuscitation：RapidfluidreplacementsBloodtransfusion>

3%NaCIsolution；©Managementofprimarydiseases；©Managementofmetabolicacidosis；

©Vasoactivedrugs；Maintainingvitalorgan'sfunction：ARDS:MachinicVentilation、ARF:

Hemodialysis；⑥ManagementofDIC；©Steroids；©Otherdrugs(Calciumblocker,ATP)o

4、MODS的防治PreventionandTreatmentofMODS—①Hemodynamicstabilizing②

Infectioncontrol③Organdysfunctionearlyidentification@Gutbarrierprotection⑤Homeostasis

maintaining@lmmunefunctionmodulatingo

5、SIRS的诊断DiagnosisofSIRS一①Bodvtemperature>38℃,or<36c②Heartrate>90bpm

③Breath>20/min,orPaCO2<4.3KPa④Whitecellcount>12xlO9/Lzor<4xlO9/L,orimmature

cells>10%

6、二低血钾的病因和诊断-一(1)Cause：①parenteralnutritionwithinadequatepotassium

replacement,©movementofpotassiumintocells：acidosis,injectionofglucoseandinsulin③

prolongedadministrationofpotassium-freeparenteralfluidswithcontinuedobligatoryrenalloss

ofpotassium@excessiverenalexcretion(lg/500ml)：useofdiureticdrug(5)lossof

gastrointestinalsecretions.(2)诊断：血钾低于3.5mmol/L表示有低钾血症。

常见原因有：①长期进食不足；②补液病人长期接受不含钾盐的液体，或静脉营养液中钾盐

补充不足；③应用吠塞米等利尿剂，肾小管性酸中毒，急性肾衰竭多尿期，醛固酮过多，使

钾从肾排出过多。④呕吐、持续胃肠减压、肠疹等，钾从肾外途径丧失；⑤钾向组织内转移，

见于大量输注葡萄糖和胰岛素，或代谢性、呼吸性酸中毒。

7、•高钾血症的原因和处理原则一(1)Cause：①overintakeofpotassium②severeinjuryor

surgicalstress③Acidosis④thecatabolicstate,©oliguricoranuricrenalfailure；(2)Treatment:

(Dintravenousadministrationof1gm.of10%calciumgluconateunderECGmonitoring；②

administrationofbicarbonateandglucosewithinsulin(lp/4gG)；③Rapidalkalinizationofthe

ECFwitheithersodiumlactateorbicarbonatepromotestransferofpotassiumintocells；④

definitiveremovalofexcesspotassiumbycation-exchangeresins,peritonealdialysis,or

hemodialysis.

高钾血症有导致病人心脏停搏的危险，一经诊断，应积极治疗，首先应立即停用一切含钾的

药物或溶液。并采取以下措施以降低血钾浓度；①促使K+转入细胞内：输注碳酸氢钠溶液；

输注葡萄糖溶液及胰岛素；②阳离子交换树脂的应用；③透析疗法。

8、外科补钾注意事项①Nomorethan40mmolshouldbeaddedto1literofintravenousfluid；

②Therateofadministrationshouldnotexceed20mmol/hourunlesstheECGisbeing

monitored.③Administrationofpotassiumisabout3-6g/day；④补钾应在尿量大于40ml/h后

进行。(休克未纠正时先纠正休克再补钾)；⑤复查血钾浓度，注意酸中毒的影响。

9、-水中毒waterintoxication的定义、病因和临床表现(1)定义：水中毒又称稀释性低

血钠，系指机体的摄入水总量超过了排出水量，以致水分在体内潴留，引起血浆渗透压下降

和循环血量增多。(2)病因：①各种原因致抗利尿激素分泌过多;②肾功不全，排尿能力下

降；③机体摄入水分过多或接受过多的静脉补液c(3)临床表现：①急性水中毒发病急骤,

水过多致脑细胞肿胀可造成颅内压增高，引起一系列神经、精神症状，如头痛、嗜睡、躁动、

精神紊乱、定向力障碍、谄妄，甚至昏迷。②慢性水中毒症状往往被原发病症状掩盖。可有

软弱无力、恶心、呕吐、嗜睡等。体重明显减轻，皮肤苍白而湿润。

10、■麻醉前准备/用药的目的Aimsofpreanestheticpreparation&preanesthetic

medication—（好心情、高痛阈、抑分泌、除反射）①Releasepatient'stensionanxietyandfear

©Increasethepainthreshold③Inhibitthesecretionofrespiratoryglands④Eliminatethe

harmfulreflexcausedbysurgeryoranesthesia,especiallytheVagalreflex<>

11、•局麻药毒性反应常见原因・一intravascularinjectionandoverdosage,Allergicreactiono

12、全身麻醉的并发症及其治疗Complicationsandtreatmentsofgeneralanesthesia一①

Regurgitation（反流）&aspiration（误吸）:Reducethegastriccontentretention;Promotinggastric

emptying;lowerthePH;Reducestomachinnerpressure;enhancetheprotectionofairway；②

Upperairwayobstruction:opentheairway;eliminatethesecretionandforeignbody;

tracheotomy；③Lowerairwayobstruction:maintainthesuitabledepthofanesthesiaand

oxygenation;intravenousinjectionofaminophylline（氨茶碱）orhydrocortisone（氧化可的松）

whennecessary；④Inadequateventilation:mechanicalventilation;antagonist;assistor

controlthebreath；⑤Hyoxemia:oxygentherapy;mechanicalventilation；⑥Hypotension:

complementofbloodvolume;vasoconstrictor;etiologicaltreatment；⑦Hypertension:

intramuscularinjectfentanyl（芬太尼）beforegeneralanesthesia;modulatethedepthof

anesthesiaduringsurgery;inducedhypotension；⑧Arrhythmia:etiologicaltreatment；⑨

hyperpyrexia（高热）hyperspasmia（抽搐）convulsions（惊厥）:physicalcooling,especially

theheadincaseofencephaledemao

13、脊髓麻醉和硬膜外麻醉的禁忌症Contraindicationstospinalanesthesiaandextradural

block--©Anticoagulanttherapy②Sepsisonskinofback③Hypovolemia④Activebacterialor

virusinfectionsoftheperipheralandcentralnervoussystem.©Elevationofintracranialpressure.

14、蛛网膜下腔麻醉/腰麻的并发症Subarachnoidanesthesia（alsocalledlumbaranesthesiaor

spinalanesthesia）-■■-©Complicationduringsurgery:Fallofbloodpressure;Heartrate

decreases;Respiratorydepression;Nauseaandvomit©Complicationaftersurgery:Headache;

Uroschesis（尿潴留）;Purulentmeningitis;Cranialnerveparalysis;Adhesivearachnoiditis（粘连

性蛛网膜炎）；Tailplexussyndrome（尾丛综合征）。

15、硬膜外阻滞的并发症Epiduralblock—①Complicationduringsurgery:Totalspinal

anesthesia;Toxinreactionoflocalanesthesia;Fallofbloodpressure;Respiratorydepression;

Nauseaandvomit；©Complicationaftersurgery:Nerveinjury;Epiduralhematoncus（硬膜夕卜血

肿）;Epiduralabscess;Spinalanteriorarterysyndrome（脊柱前动脉综合征）。

16、硬膜外麻醉的适应症--颈部以下的，非开胸的手术。

17、ICU的纳入条件WhocanbeadmittedtotheICU--①Trauma&Majorsurgery®

Monitoringafterorgantransplant③Circulationdecompensation®Havepotentialofrespiratory

failureandneedrespiratortreatment©Severedisturbanceofwaterandelectrolyteand

acid-baseimbalance⑥AnestheticaccidentorafterCPR⑦Singleormultipleorgandysfunction®

Severemetabolicdisorderso

18、氧疗的指征OxygentherapyindicationCardiacandrespiratoryarrest;Respiratoryfailure

typeI,typeII;CardiacfailureorMl;Shock;Increasemetabolicdemands;Post-operative

states'Carbonmonoxidepoisoning

19、心脏骤停的原因Commoncausesofcardiacarrest©Primary:Suddencessationofheat

function;Myocardialischemia;日ectricshock;Drugs,e.g.Potassium②Secondary:

Asphyxia,hypoxia,hypercarbia;Centralnervoussystemfailure;Metabolic/electrolytedisorders;

Temperatureextremes;Toxins;Acuteanaphylaxiso

20、心肺脑复苏的标准过程StandardprogrammingofCPCR-iA(AssessmentandAirway)

神志判定与畅通气道B(Breathing)人工呼吸C(Circulation)重建循环D(Drugsandfluids)

药物与输液E(ECG)心电图F(Fibrillationtreatment)电除颤G(Gauging)评估H(Human

mentation)恢复神志I(Intensivecare)重症监护

21、初期心肺复苏的三个步骤，心脏挤压的有效标志--1Aairway(开放气道)Bbreathing(人

工呼吸)Ccirculation(胸外心脏按压建立人工循环)2有效标志是:①大动脉处可扪及波动

②紫绡消失,皮肤转为红润③可测得血压。

22、触电致心跳呼吸停止，徒手抢救的措施-一(1)保持呼吸道畅通Airway：头后仰，托起

下颌；(2)人工呼吸Breath：①口对口人工呼吸，一手捏患者鼻子,使其头后仰托起下颌，深

吸一口气口对口缓慢吹起，使患者胸廓隆起，离开患者口，放开鼻子，患者肺内气体呼出②口对

鼻人工呼吸,将患者口捏住,从鼻子吹起，其他同上；(3)胸外心脏按压Circulation：患者仰

卧于地板上，抢救者跪于患者一侧双手交叉，双臂伸直，手掌压在患者胸骨中下1/3交界处，

垂直下压3~4cm,立即放松，放松时手掌不离开胸壁，挤压与放松时间相等，频率60-80次/

分(或80~100次/分)，一人抢救时，每挤压心脏15次行人工呼吸2次；如果俩人抢救，每

挤压心脏5次，行人工呼吸1次，直至患者心跳呼吸恢复或救护车到来。

23、气管插管分类■一①根据插管途径分:经口腔插管，经鼻腔插管，经气管造口插管;②根据声

门是否暴露:明视插管法,盲插插管法；③根据病人是否清醒:清醒气管插管、诱导气管插管:

保持自主呼吸插管无自主呼吸插管。

第一章总论感染、创伤烧伤冻伤、器官移植、显微外科及手外伤

名解

工、••夕卜科感染Surgicallnfection——Presenceofinfectionthatmustberesolvedbysurgical

procedureoroccursinanoperatedsite.

2、二急性蜂窝织炎Acutecellulitis—acuteinflammationoflooseconnectivetissue,usually

occurssubcutaneously,subfascially,inintermuscularspaceordeepcellulite,mostlycausedby

hemolyticstreptococcus.

3、••丹毒Erysipelasacuteinflammationoflymphaticcapillarynet,mostlycausedbyhemolytic

streptococcus.

4、Superinfection--anewinfectionthatdevelopsduringantibiotictreatmentfororiginal

infectiono

5、Furuncle拜acutesuppurateinfectionofsinglefolliculuspiliwithitsglandulaesebaceae

6、Carbuncle痈--acutesuppurateinfectionofmutiplefolliculuspiliwithitsglandulaesebaceae.

7、Tetanus破伤风Adiseasecausedbytetanospasmin,apowerfulproteintoxinproducedby

ClostridiumTetani.Tetanususuallyoccursafteranacuteinjury,suchasapuncturewound.

8、气性坏疽GasgangreneAclostridialinfectiontypicallyinvolvesunderlyingmuscle,isalso

termedclostridialmyonecrosis.

9、•牵涉痛一某些内脏器官病变时,在体表一定区域产生感觉过敏或疼痛感觉的现象，称为

牵涉痛。

10、•清创术debridement一是用外科手术的方法,清除开放伤口内的异物，切除坏死、失活

或严重污染的组织、缝合伤口，使之尽量减少污染，甚至变成清洁伤口，达到一期愈合，有

利受伤部位的功能和形态的恢复。

11、•深2°烧伤DeepSecondDegreeInvolvingdermisthickerthansuperficialone；Heal

spontaneouslyin3-4weekswithscar&dysfunction；Wet,swollen,mottledspot,lesspain,small

blister；Needskingraftingo

12、•重度烧伤Seriousburn-IIdegreeburnUnder31%~50%,orIIIdegreell%~20%,orless

thanabovedatabutaccompanywithshock、respiratorytractburnorseverecombinedinjure。

13、FirstDegreeburn-Limitedtotheepidermalskinlayer;oftenminimallytoquitepainful;

Mosthealspontaneously;Erythematous,blanchwithlightpressureo

14、SuperficialSecondDecree--Buminjuriesinvolvethefirsthalfofthedermis；Healwithin2

weeks；Noscarunlessinfectionsetsin；Blister;painful；Wet,swollen&rednesso

15、ThirdDecree-Fullskinlayerinjuried；Nospontaneouslyhealunlesstheareaofburnis

relativelysmall(3cmdiametter)；Differentappearanceduetofixedhemoglobininthesubdermal

region.Dry,nopain,Needskingraftingo

16>Mild—IIdegree,TBSAlessthan10%。

17、Middle-IIdegreell%^30%,orIIIdegreelessthan10%。

18、Extraserious-morethan50%,orIIIdegreeover20%,orsevereinhalationinjure^

combinedinjure。

19、烧伤BURNS(Thermalinjury)—Tissueinjurycausedbyheat,hotliquid(water,soup,

oil),steam,flame,megatemperaturegas,intenseheatmetal,liquid,solid,electriccurrent,

chemicals,laser;radioactiveray,explosion。

20、移植Transplantationisthemovingofviablecells,tissuesororgansfromonebodyto

another(orfromadonorsiteonthepatient'sownbody),forthepurposeofreplacingthe

recipient'sdamagedorfailingcell,tissueororganwithaworkingonefromthedonorsite.

21、同系移植Isotransplantation-Organsortissuesaretransplantedfromadonortoa

geneticallyidenticalrecipiento

22、异体移植术Allotransplantation-Organsortissuesaretransplantedfromadonortoa

geneticallynon-identicalmemberofthesamespecieso

23、异种器官移植Xenotransplantation-Transplantingorgansortissuesfromonespeciesto

another<,

24、热缺血时间Warmischemiatime(WIT)—indicatestheperiodfromthestopofbloodsupply

ofdonororgantothebeginningofcoldperfusion,WIT<10minuteso

25、冷缺血时间Coldischemiatime(GT)…indicatestheperiodfromcoldperfusiontorecovery

ofbloodcirculationofthegrafts,includingthewholepreservationtime。

简答

1、夕卜科感染的临床表现ClinicalmanifestationsofSurgicalInfection①localsymptoms:

redness,swelling,hotness,painandorgandysfunction.②systemandorgandysfunction,SIRS,

Septicaemia@constitutionalsymptoms:fever;tachycardia,headache,malaise©Special

symptoms:破伤风肌强制性痉挛，气性坏疽皮下捻发音，炭疽发养性黑色脓疱。

2、•非特异物感染的转归一①炎症好转②局部化脓③炎症扩展④转为慢性炎症。

3、■•手部感染的解剖学特点一(1)①Palmskinisthickerandmorekeratinizedskinoftheback

ofhand.Sopalmsubcutaneouspurulentinfectioncanpenetratedermisandformadumbbell

-likeabscessunderneaththekeratinocytelayer.②Dorsalinfectionismoreswellingbecauseall

lymphinhanddrainsthroughdorsallymphaticvessel.(2)①Thereareverticalfibercords

connectingpalmdermisandperitoneumofdeepdistalphalanges,tendonsheathofproximal

interphalangealjointsanddeeppalmfascia,whichseparatethesubcutaneoustissueinto

relativelyclosesspace.Infectionwillnotbeeasilyspread.©Severepainandobvious

constitutionalsymptomsoccurbecauseofthehighpressure.Invasionintodeeptissuewill

happenbeforelocalsuppuration,causingOsteomyelitis,synovitis,tenosynovitis.(3)Thereare

connectionsbetweenpalmtendonsheath,synovialbursa,deeppalmarinterspace,andbetween

intermuscularspacesofforearm.Sopalmarinfectioncanspreadtodeepandproximalfollowing

somepatterno

4、■烧伤的并发症一①Pulmonary:moreoften,within2PBW@Renal:shockandinfectionare

maincauses.infectiveRFismorelikenon-oliguric③Cardiac:shockheart:shockandinfection,

payattentiontocardiacprotection④Stressulcer:applicationofantacid⑤Cerebraledema。

5、烧伤性休克的液体复苏Fluidresuscitationofburnshock…・TMMUformula:①Fluidinfusion

during1st24hours:0.5mlcolloidand1mlelectrolytesperkgofbodyweightevery1%IIor

IIIdegreeTBSAinadults,withadditional2000mlwater(5%glucose).Halfofthetotalamount

wasinfusedduringthefirst8PBHs,whiletheotherhalfwasinfusedatthelatter16PBHs；②

Fluidamountduringthe2nd24PBHs:Halfoftheelectrolytesandcolloidinfusedpracticalinthe

1st24PBHs.Withthewater2000ml.③Noupperlimitforthefluidinfusion.Andthosewith

morethan50%TBSAshouldreceivefluidaccordingly.

第一个24小时，每1%烧伤面积(2、3度)每公斤体重应补胶体和电解质液共1.5ml(小

儿2.0ml)o胶体(血浆)和电解质(平衡盐液)的比例为0.5:1,广泛深度烧伤者与小儿

烧伤者其比例可改为0.75:0.75.另加以5%葡萄糖溶液补充水分2000ml(小儿另按年龄、

体重计算)，总量的一半应于伤后8小时输入。第二个24小时，胶体和电解质为第

一个24小时的一半，水分补充仍为2000mlo

举例：烧伤面积60%、体重50KG病人，第一个24小时补液补液总量为：

60*50*1.5+2000=6500ml,其中胶体为60*50*0.5=1500ml,电解质液为60*50*l=3000ml,

水分2000mlo

6、•外科手术洗手穿手术衣后的无菌范围-一背部、腰部以下和肩部以上部位为有菌地带。

7、甲沟炎的临床表现Paronychiaclinicalmanifestation一一①Usuallyhappeninsubcutaneous

tissueofnailgrooveofonesideinearlystage.Redness,swellingandpain.②Fluctuationoccurs

asprogressing,whitepusspotsbutnoteasilyulcer.③Canspreadtooppositeside@Pusunder

nail.Progresstowhitlowandevenconstitutionalsymptoms.

8、全身性外科感染的临床表现一A.suddenonsetoffever,40-41°,orhypothermia,progress

rapidlyB.headache,nausea,vomit,abdominaldistention,sweating,deliriumorcoma。C.

tachycardia,weakandrapidpulse,dyspnea.D.HepatosplenomegalyzjaundiceandSubcutaneous

petechiaeo

9、总体表面积的划分TotalBodySurfaceAreaTBSA(9method)--3head,3face,3neck,5

hands,6forearms,7upperarms,13bellyandchest,13backand1perineum,5hips,7feet,13

crus,21thigho

10、烧伤的治疗原贝!1Treatmentprincipleofburntrauma—(L)Mild：debridement,wound

protection；(2)Severe：©Earlytimelyfluidinfusion,airwayunobstructed,modifyHypovolemic

shock②Earlycutofsevereburnedtissue,autologousorallogenicskintransplant③Modify

shock,controlinflammationincaseofMODS④Payattentiontotherecoveryofmorphologyand

functiono

11、创伤的并发症Complicationoftrauma・一①nfection；②Shock；@Fatembolismsyndrome

FES；©Stressulcer；©Coagulationdysfunction；©Organdysfunctiono

12、手烧伤的治疗原则Manageprincipleofhandbum--・・(SuperficialIIdegree,exposureor

bandage,handsinfunctionpositionwhenbandage；②Earlytangentialexcisionorescharectomy

andskingraftingwithlargesheetautosplitskin；©Circumferentialescharofwristandfingers,

earlyescharotomyo

13、微血管吻合的原则Principlesofmicrovascularanastomosis—①Normalvessel②Normal

bloodflow(3)propertension@approximatecalibre©eversionsuture©micro-invasiono

14、手部伤的治疗原贝!]Basicprinciplesoftreatmentofhandinjury-①Bleedingcontroland

preventfurthercontamination©Carefulassessmentsofinjuryandallstructures③Debridement

in6-8h④Trytorepairallstructuresintheprimaryphase⑤Trytoclosethewoundintheprimary

phase©correctaftercareandhandimmobilizationinfunctionpositiono

15、病例一男性青年不慎跌入水温近100C水池中。伤后即急诊入院救治。体检:体重60

公斤，神情，但面色苍白，脉搏快、弱，双下肢、会阴部布满水泡，背部均起红斑。请分析并试述:

①该伤者烧伤面积是多少？属烧伤严重度哪一类？②伤后24小时的补液量，种类和方法。③

临床调节补液速度最简便实用的监测指标是什么？

答：①(三三三五六七，十三十三二十一，双臀占五会阴一，小腿十三双足七)或(3,33；

5,6,7,；5,7,13,21,；13,13,1)烧伤面积是47%,II度，属重度烧伤

②第1个24小时补液量(其中晶胶体可用2:1或1:1方案)47(60)*1.5*60体重+2000生

理需要量=4230(5400)+2000毫升二6230(7400)毫升其中晶体液2820(4933)毫升,

胶体1410(2467)毫升，葡萄糖液2000毫升

补液方法:伤后8小时渗出迅速，使血容量减少，故第1个24小时额外损失量的1/2应在伤后

8小时内补入体内。其余量在伤后16小时均匀输入。

补液种类:晶体液用平衡盐液或等渗盐水，胶体用血浆或低分子右旋糖酊③每小时尿量尿量达

40ml/h时才能补钾④口服者尽量改为口

第二章头颈部

名解

1、=继发性脑损伤seconderybraininjury—Delayedbraintissuepathologicalchangesoccur

afterinjury,mainlybrainedemaandintracranialhematoma.

2、二颅内压升高Raisedintracranialpressure-aclinicalpathogenicsyndromeresultsformthe

continuouslyincreasedintracranialpressionupto2.0kPa(200mmH20)andenlargementofthe

cranialcavitycontentwhichusuallycausedbythecraniocerebralinjure,braintumor;

hematencephalon,hydrocephalusandinflammation。

3、二二中间清醒期Lucidinterval-Whenprimaryinjuryismild,comausuallylastsshortly.When

hematomaformationisnotrapidenough,thereisatimeintervalbetweencomacausedby

primaryinjuryandsecondarycomacausedbybrainhernia,duringwhichthepatientisoften

conscious.Itusuallylastsforhours.

4、脑疝Brainhernia-Braintissueshiftsthroughrigidopeningsofskull(suchasthefalx

cerebri(大脑镰)，thetentoriumcerebelli(小脑幕),andtheforamenmagnum),compressother

structuresofthebrainandproducingtheobservedsyndromeso

5、小脑幕切迹疝UncalHerniation--uncusoftemporallobeherniatesdownthroughtentorial

notcho

6、枕骨大孔疝TonsillarHerniation--cerebellartonsilsherniatethroughforamenmagnum。

7、==Langlitt曲线/体积压力反应Volume・PressureResponse—如果原有的颅内压增高已超过

临界点，释放少量脑脊液既可使颅内压明显下降，若颅内压增高处于代偿的范围内，释放少

量脑脊液仅引起微小的压力下降。

8、==Cushing反应一颅内压急剧增高时,病人出现血压升高、心跳和脉搏缓慢、呼吸节律紊

乱及体温升高等各项生命体征发生变化。

9、==颅内压增高"三主征"一①Headache②Vomiting③Papilledema。

10、==熊猫眼征Raccooneves——Generalizedeperiorbitalcchymosisandnosebleedinfractureof

anteriorcranialfossa,whichlookslikepanda'seyes.

11、==Battle征…Ecchymosisinthepostauriculararea,happenedinfractureofposteriorcranial

fossa.

12、==脑震荡CerebralconcussionTransientneuraldisorder,Nosigns,CT(-),Nogross

pathologicalfindings,Neurofibersdisturbedinmicroscope.

13、==原发性脑干损伤Primarybrainsteminjury-Unstablevitalsigns,Deepcoma,instantly,

constantly,Changeofbrainstemreactions,Nobrainherniation,Diffuseaxonalinjury.

14、==迟发性外伤性颅内血肿Delayedtraumaticintracranialhematoma-Thefirstposttrauma

CTscandetectsnohematoma,butcanbefoundinlaterCT,ornewhematomaoccurswhere

thereisnohematomapreviously.

15、脑挫裂伤Cerebralcontusion--主要发生于大脑皮层的损伤。

16、逆行性遗忘Retrogradeamnesia-Patientswithcerebralconcussioncannotrecallthe

conditionwhentheinjuryoccursandevenconditionspriortothetrauma.

简答

1、••颅内压增高症状一①Headache②Vomiting③Papilledema④Disturbanceofconsciousness

andchangesofvitalsigns⑤Others。

2、•颅内压增高原因Reasonsofincreasedintracranialpressure——①EnlarRementofthecranial

cavitycontent.Suchasthevolumeofbraintissueenlargement(encephaledema),CSF

increases(hydrocephalus),backflowobstructionoroverinfusionofcerebralveins,bloodvolume

increases.②Intracranialspacerelativelydecreasescausedbythespace-occupyinglesion.Suchas

hematoma,tumor,abscess③Intracranialspacedecreasescausedbycongenitalmalformation.

Suchascraniostenosis(狭颅症

3、==颅内压升高的治疗原则一(1)Generalmeasures：Anti-convulsants、Antacids>Nutritional

support；(2)Specificmeasures：©ReductionCSFbyexternalventricularcatheterdrain(ifacute)

orshunt,©Reductionincerebraledema(Dehydration):Osmoticdiuretics-mannitol,Loop

diuretics-lasix,Steroid:dexamethasone,Solu-Medrol,andalbuminet.Al,©Reductionincerebral

bloodflow:Hypothermia,Barbituratetx,HyperventilationtopCO2=30-35mmHg；(3)Causes

treatment:©Surgicalremovalofprecipitatingcause(masslesion)②Useantibioticstocontrol

intracranialinfectivedisease。

4、颅内压升高的后果Consequenceofincreasedintracranialpressure■一©Decreasedcerebral

bloodflow,ischemia,braindeath②Brainshiftandcerebralhernia③Encephaledema④Cushing

reaction⑤Gastrointestinaldysfunctionandalimentarybleeding⑥Neurogenicpneumonedemao

5、・<］、脑幕切迹疝I临床表现transtentorialhernia(alsocalledtemporallobehernia)一一①

Symptomsofincreasedintracranialpressure:progressivesevereheadachecompanieswithfidget,

frequentvomiting；②ChangeofpupH:earlystage(myosis,decreasedordisappearedoflight

reflex);latestage(mydriasis,disappearedoflightreflex)；③Dyskinesia运动障碍:decreasedor

paralyticmu