急性胰腺炎护理查房

地形平坦开阔，地层由第四系全新冲积层，第四系上更新统冲层组成，局部表覆第四系全新统人工堆积层。第四系全新统冲积层厚度约25～50m，岩性主要为黏土、粉质黏土、粉土、粉砂、细砂；第四系上更新统冲积层厚度大于50m，岩性主要为黏性土、粉土、粉细砂等。管桩深度范围内地层主要为：粉土、黏土、粉质黏土，局部表层为杂填土。couplingCentreshallbechecked,thesecondpouredconcretestrengthofmorethan70%.Intheprocessofreamingorboring,apartfromthespecialprovisionsinfactory,doesnotallowanyworkthatmayaffectthecouplingCentre,suchasirrigation,tocylinderconnectionstofloodthecondenserpipesandsoon.Wellboring,hingeboltholeflangewithcouplingofvertical,notoblique.Mountingboltsshouldbeaddedlubricants,typinggentlywithasmallhammer,nottoolooseortootight,packedtheboltswiththecorrespondingsealscrewholeshouldbemarked.6.4.5.4.2couplingreamedandpairingsisclosetothediameterofboltbearinggoodhingeholes,dressedwithagoodtwocouplingboltsbeforeyoucanmovetherotor,boring-reamingholeinturn.Couplingboltsmustbetightcouplingissymmetricaldiameter,inboring,reaming,twoboltsout.Wellboring,hingeboltholeflangewithcouplingofvertical,notoblique.Duetothecouplingboltsinaccordancewithhingeholescorrespondingtothediameterofthescrewholesonebyoneafterprocessing,processingbackboltinstallationlocationcannotbechanged,soaccordingtoboltaftertheactualweightdifferenceofnutandlockwashertomatch.Generalrequirementsforcouplingtwosymmetricaldiameterbolt,nutandlockwasher'stotalweightdifferenceshouldnotbegreaterthan10gandknocksstampedmark.(SeeFigure18)Thecouplingboltsapplylubricant,andthengentlywithcopperhome,nottoolooseortootight.BoltAssemblyisfinished,symmetricaltighteningallboltsto30%,50%,70%,100%force,andcheckthecouplingflutterandbeforeconnectingthecirclegraduallychangesitsvalueshouldbelessthan0.02mm.Tighteningtorqueofthecouplingboltsshallcomplywiththetechnicalrequirementsmanufacturersdrawings,withadynamometricwrenchorlogtensiontools.Threewheelrotorswingtestcouplingconnectionsshouldbechecked:takingleave,急性胰腺炎教学查房【病史】概念：急性胰腺炎―――是指胰腺分泌的消化酶引起胰腺组织自身消化的化学性炎症。胰腺为什么会发生自身消化？在什么情况下自身消化？――导出病因。一、病因与发病机制（一）病因1．胆道疾病为我国AP最常见的病因，其中胆石症更为常见。▲分析机制：据统计约2/3人群中胆总管和胰管共同汇合于肝胰壶腹，汇合后进入十二指肠，胆管炎症、结石、寄生虫、水肿、痉挛等病变使壶腹部发生梗阻，加之胆囊收缩，胆管内压力升高，胆汁通过共同通道反流入胰管，激活胰酶原，导致胰腺自身消化而引起胰腺炎。此外胆石、胆道感染等疾病尚可造成Oddi括约肌功能障碍，引起十二指肠液反流入胰管，激活胰腺消化酶诱发AP。2．胰管梗塞因蛔虫、结石、水肿、肿瘤或痉挛等原因可使胰管阻塞，胰液排泄受阻，当暴饮暴食胰液分泌过多时，胰腺内压力增高，致使胰泡破裂，胰酶原进入间质，被组织液激活引起本病。3．十二指肠乳头邻近部病变导致十二指肠内压力增高及Oddi括约肌功能障碍，致十二指肠液反流入胰管引起胰腺炎。4．酗酒和暴饮暴食是西方国家的主要病因。▲分析机制：乙醇可引起Oddi括约肌痉挛，同时乙醇兴奋迷走神经，使胃泌素，胰泌素和胆囊收缩分泌，这三种激素均促使胰腺外分泌旺盛，由于胰管引流不畅，造成胰液在胰胆管系统压力增高并郁积，致使高浓度的蛋白酶排泄障碍，最后导致胰腺泡破裂而发病。5．手术与损伤胃、胆道等腹腔手术，腹部钝伤挤压胰实质，或逆行胰胆管造影注射造影剂过多或压力过高时，也可引起胰腺炎。6．其他高钙血症与甲状旁腺机能亢进可诱发AP。药物中如可使胰液的分泌及粘稠度增加。某些传染性疾病如可伴有胰腺炎。（二）机制（三）分型1.轻症急性胰腺炎（急性水肿型胰腺炎）：多见，预后好。2.重症急性胰腺炎（急性出血坏死型胰腺炎）：少见，但很危险。地形平坦开阔，地层由第四系全新冲积层，第四系上更新统冲层组成，局部表覆第四系全新统人工堆积层。第四系全新统冲积层厚度约25～50m，岩性主要为黏土、粉质黏土、粉土、粉砂、细砂；第四系上更新统冲积层厚度大于50m，岩性主要为黏性土、粉土、粉细砂等。管桩深度范围内地层主要为：粉土、黏土、粉质黏土，局部表层为杂填土。couplingCentreshallbechecked,thesecondpouredconcretestrengthofmorethan70%.Intheprocessofreamingorboring,apartfromthespecialprovisionsinfactory,doesnotallowanyworkthatmayaffectthecouplingCentre,suchasirrigation,tocylinderconnectionstofloodthecondenserpipesandsoon.Wellboring,hingeboltholeflangewithcouplingofvertical,notoblique.Mountingboltsshouldbeaddedlubricants,typinggentlywithasmallhammer,nottoolooseortootight,packedtheboltswiththecorrespondingsealscrewholeshouldbemarked.6.4.5.4.2couplingreamedandpairingsisclosetothediameterofboltbearinggoodhingeholes,dressedwithagoodtwocouplingboltsbeforeyoucanmovetherotor,boring-reamingholeinturn.Couplingboltsmustbetightcouplingissymmetricaldiameter,inboring,reaming,twoboltsout.Wellboring,hingeboltholeflangewithcouplingofvertical,notoblique.Duetothecouplingboltsinaccordancewithhingeholescorrespondingtothediameterofthescrewholesonebyoneafterprocessing,processingbackboltinstallationlocationcannotbechanged,soaccordingtoboltaftertheactualweightdifferenceofnutandlockwashertomatch.Generalrequirementsforcouplingtwosymmetricaldiameterbolt,nutandlockwasher'stotalweightdifferenceshouldnotbegreaterthan10gandknocksstampedmark.(SeeFigure18)Thecouplingboltsapplylubricant,andthengentlywithcopperhome,nottoolooseortootight.BoltAssemblyisfinished,symmetricaltighteningallboltsto30%,50%,70%,100%force,andcheckthecouplingflutterandbeforeconnectingthecirclegraduallychangesitsvalueshouldbelessthan0.02mm.Tighteningtorqueofthecouplingboltsshallcomplywiththetechnicalrequirementsmanufacturersdrawings,withadynamometricwrenchorlogtensiontools.Threewheelrotorswingtestcouplingconnectionsshouldbechecked:takingleave,二、临床表现★1．症状（1）腹痛：出现最早、最常见，为本病的主要症状。突然发作，常于饱餐和饮酒后1～2h发病，疼痛为持续性，有阵发性加剧，呈纯痛、刀割样痛或绞痛，常位于上腹或左上腹，可向腰背部呈带状放射，仰卧位时加剧，坐位或前屈位时减轻。轻症AP腹痛轻，3～5天内缓解，重症AP时间延长。当有腹膜炎时，疼痛弥漫全腹。（2）发热：多数病人有中度发热。轻症AP的发热在3～5天内可自退；重症AP呈高热或持续不退，多表示胰腺或腹腔有继发感染。（3）恶心、呕吐与腹胀：起病时有频繁恶心、呕吐，呕吐物为当日所进食物。重症AP呕吐剧烈，可吐出胆汁或咖啡渣样液，呕吐后腹痛并不减轻，同时伴有腹胀，伴麻痹性肠梗阻时腹胀尤为显著。▲提问：频繁的恶心呕吐可导致？――脱水，电介质酸碱平衡紊乱。（多有轻重不等的脱水，呕吐频繁者可有代谢性碱中毒。出血型坏死的病人有明显脱水与代谢性碱中毒，重症病人可因低钙血症而引起手足搐搦，血钾及镁均可降低。）（4）黄疸：较少见，于发病后第2～3天可出现轻度黄疸，数天后即消退，此系胰头部水肿压迫胆总管引起，亦可因并发胆管结石或感染所致。（5）休克：见于重症AP，是最严重的表现。病人可突然出现烦躁不安，皮肤呈大理石样斑状青紫，四肢湿冷，脉搏快细，血压下降。▲分析休克的原因：呕吐使大量的消化液丧失，麻痹性肠梗阻时大量消化液积于肠腔、腹腔及胰腺后间隙造成低血容量，血管通透性增加，周围血管扩张等，大量的渗血、出血可使循环血容量更为不足。此外胰腺还可能分泌一种抑制心肌的