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1、肠结病(不完全性肠梗阻)中医诊疗方案一、诊断(一)疾病诊断一.中医诊断:参照《中医急诊学》(普通高等教育“十五”国家级规划教材,中国中医药出版社,2007年)。(1)主要症状:不同程度和性质的腹痛,腹胀,呕吐,排气排便减少或停止。(2)影像学检查:立体腹部平片或腹部CT扫描可见小肠、结肠充气扩张,可见液平面。具备2个主症以上,结合影像学检查结果即可确诊。本病可见任何年龄段,以术后、年老体弱者多见,常反复发作,难以根治。二.西医诊断:根据《临床诊疗指南-外科学分册》(中华医学会编著,人民卫生出版社),《外科学》(第7版,人民卫生出版社),《胃
2、肠外科学》(人民卫生出版社)。1、腹痛:(1)阵发性剧烈绞痛:见于单纯性机械性肠梗阻。(2)间歇性、持续性、阵发性加剧腹痛:提示绞窄性肠梗阻。(3)持续性腹胀不适,无阵发性腹痛,提示麻痹性肠梗阻。2、呕吐:梗阻发生后很快发生,早期为反射性的;呕吐物为胃内容物。fieldisdownwind,broodingHouseseparatefromthebreedingshed,and...Buildingchickenfarmsmustalsoconsidertheconstructionofchickenmanuretreatmentfacil
3、itiessuchasseptictanks,methane-generatingpit,donotletthechickenmanuredirectly.Fivetodoadiseasepreventionandcontrol,donotcutcorners.Builtintothechickeninchickenfarm,willberequiredtodoavarietyofvaccineinjectionsanddisinfectioninchickenfarm,donotholdthechance,anddoscientificf
4、arming.Reasonableproblemsinbuildingachickencoophenhouselayout,canprovideagoodenvironmentforchicken,makingitsfullproductivepotential,sootherthaninunderstandingthephysiologicalcharacteristicsofthechickenitself,andmustbeproperlyplannedandconstructedsheds.Achickenlayoutconside
5、rations1.Sitestochooseawayfrompopulatedareas,trafficconvenient,awayfromtheroad2.Gaozaoterrain,alotofsunshine.Wintersunaspossible,summerwind,andnotaftertherainwater.Larger,leavingroomfordevelopment3.Abundantwaterresourcespollution-free,easytoaccess,sufficientpowerisguarante
6、ed4.Buildingstructure,theeconomy,savingmoney,andsavingenergy,itisfacinginaccordancewithlocalenvironmentalandphysiologicalcondition,lightingisgood,easytoventilation,easytooperate,soconducivetocoolinginthesummer,toinsulationinwintercold5.Layoutofpremisesshouldbereasonable,do
7、distinguishbetween9(1)呕吐频繁,呕吐物为胃液、十二指肠液、胆汁的,见于高位小肠梗阻。(2)呕吐静止期长,1~2天开始呕吐,呕吐物为带臭味的粪样物,为低位小肠梗阻。(3)呕吐物为咖啡样物质,是肠管血运障碍的表现。(4)呕吐少为结肠梗阻。3、腹胀:腹胀程度与梗阻部位有关;(1)高位小肠梗阻,腹胀不明显;(2)低位小肠梗阻,全腹膨胀,有肠型。(3)麻痹性肠梗阻全腹膨胀显著,无肠型。(4)闭袢性肠梗阻腹部膨隆不对称.4、停止排气排便5、体征:(1)腹部视诊:机械小肠梗阻可见肠型和蠕动波;肠扭转时腹胀多不对称;麻痹小肠梗阻肠鸣音
8、减弱或消失。(2)腹部触诊:单纯性肠梗阻可有轻压痛,无腹膜刺激征;有压痛性包快时,常为较窄的肠袢;较窄性肠梗阻可有局限性压痛和腹膜刺激征;移动性浊音见于绞窄性肠梗阻。(3)腹部听