2022年医学专题—上消化道大量出血-09-李晓玲.pptVIP免费

第一页，共三十七页。上消化道大量出血(chūxiě)的诊断与鉴别诊断第二页，共三十七页。Acommonmedicalcondition250,000–500,000admissions/yearUSUGIbleedingincidence100/100,000adultsIncidenceincreases20-30foldfromthirdtoninthdecadeoflifeIncidenceincreases20-30foldfromthirdtoninthdecadeoflifeLGIbleedingincidence20/100,000adultsOverwhelminglydiseaseoftheelderlyOverwhelminglydiseaseoftheelderlyGIbleedingstopsspontaneouslyin80%第三页，共三十七页。MorbidityDataMajoritywillreceivebloodtransfusions2–10%requireurgentsurgerytoarrestbleedingAverageLOS4–7daysMortalityratesforUGIbleeding2–15%Mortalityforpatientswhodevelopbleedingafteradmissiontohospitalforanotherreasonis20–30%第四页，共三十七页。CostsAveragehospitalcostsexceed$5,000peradmissionMostofthisforhospitalbedandICUstaysratherthanphysicianfees,bloodproducts,diagnostictests,ormedicationsReductionofhospitaladmissionsandLOShasgreatestpotentialtoreducecosts第五页，共三十七页。一、概念(gàiniàn)上消化道概念(gàiniàn)?第六页，共三十七页。第七页，共三十七页。一、概念(gàiniàn)上消化道大量出血概念部位部位出血量出血量：：指出血达全身血量的指出血达全身血量的30%~50%30%~50%时（时（1500~2000ml1500~2000ml），临床上出现低血容量性休克，收缩压＜），临床上出现低血容量性休克，收缩压＜10.7kPa(80mmHg)10.7kPa(80mmHg)，脉压差＜，脉压差＜3.3~4.0kPa(25~30mmHg3.3~4.0kPa(25~30mmHg）及脉搏）及脉搏(màibó)(màibó)快而弱（脉搏快而弱（脉搏(màibó)(màibó)＞＞120120次次/min/min），），血红蛋白＜血红蛋白＜70g/L70g/L，红细胞计数＜，红细胞计数＜33Х10Х101212/L/L。。出血速度出血速度??第八页，共三十七页。UGIbleeding:NomenclatureHematemesis25%Melenaalone25%,50–100ccofbloodwillrenderstoolmelenicHematochezia15%,seeninmassiveUGIhemorrhage“Redblood”hematemesis“Coffeeground”emesis第九页，共三十七页。二、病因(bìngyīn)按照发病机制可分为以下五类炎症性疾患(jíhuàn)：机械性疾患：血管性疾患：赘生物：全身性疾患：第十页，共三十七页。炎症性疾患(jíhuàn)第十一页，共三十七页。机械性疾患(jíhuàn)第十二页，...