上海交大外科学上血.pptxVIP

上海交大外科学上血第1页/共85页 Introduce OurselvesDr. YangDr. Li第2页/共85页 Basic Concepts第3页/共85页 What Is Massive Bleeding20% (800ml) blood lossHemodynamic instability血流动力学不稳Clinical signs of poor perfusion组织灌注差第4页/共85页 What Is UGIEsophagus食道Stomach胃Duodenum十二指肠Jejunum空肠Ileum回肠Ascending Colon升结肠Transverse Colon横结肠Descending Colon降结肠Sigmoid Colon乙结肠Rectum直肠Anus肛门第5页/共85页 第6页/共85页 第7页/共85页 Please RememberUGIB is not uncommon in the emergency roomMortality rate is about 10% UGIB is a series of diseases mainly treated by internal medicine.3-15% require a surgical procedure第8页/共85页 Let’s have a problem!第9页/共85页 Patient Come45-yr femalefirst episode of hematemesis呕血transferred from a small hospital2 units of packed erythrocyte红细胞 tranfusednasogastric tube胃管 introduced with active bleedingpulse 120 bpm, BP 80/40 mmHg第10页/共85页 What Is Your DecisionWhat is your intuition直觉?第11页/共85页 For ReferenceDoes the patient have life-threatening situation?hypovolemic shock低血容量性休克low body temperature体温降低anemia/hypoxemia贫血/低氧血症comorbidities并存病Is it a massive or minor bleeding?Where is the most probable bleeding site?第12页/共85页 Worrisome clinical signs and symptomstachycardia心动过速 more than 100 beats per minute (bpm)systolic blood pressure (SBP)收缩压 ≤ 90mmHgpostural hypotension体位性低血压 SBP decrease ≥15mmHg or pulse rate increase ≥10 bpmcool extremities四肢厥冷syncope晕厥ongoing brisk hematemesis进行性/活跃地呕血maroon stool枣红便第13页/共85页 Massive or MinorClass IClass IIClass IIIClass IVBlood Loss ml≤7507502000＞2000Blood Loss %≤1515-3030-40＞40Pulse Rate bpm≤100＞100＞120＞140Blood PressurenormalnormaldecreasedecreaseCNS 神经系统症状Slightly anxious轻度焦虑Mildly anxious中度焦虑Anxious, confused焦虑/意识模糊Confused, lethargic意识模糊/嗜睡第14页/共85页 UGIB or LGIBManifestation症状UGIBLGIBHematemesis呕血Almost certainRareMelena黑便 ProbablePossibleHematochezia 便血PossibleProbableBlood-streak stool便中带血丝RareAlmost certainOccult blood stool大便隐血PossiblePossible第15页/共85页 Estimation of Blood Lossoccult blood stool – 5-10ml/24hmelena – 50-100ml/24hhematemes