外科期末復(fù)習(xí)

目錄

第一章總論1

第二章頭頸部9

第三章胸部肺部心臟及乳房12

第四章胃腸道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統(tǒng)35

第九章骨折及關(guān)節(jié)疾病39

第十章骨與關(guān)節(jié)化膿性感染、結(jié)核及腫瘤43

第十一章運(yùn)動(dòng)系統(tǒng)的慢性損傷44

第一章總論：外科休克、水電解質(zhì)酸堿、器官功能不全與衰竭、重癥監(jiān)測治

療與心肺腦復(fù)蘇、麻醉

名解

1、=休克shock-一Aclinicalsyndromeresultsfrom團(tuán)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一當(dāng)脊髓與高位中樞斷離時(shí),脊髓暫時(shí)喪失反射活動(dòng)的能力而進(jìn)

入無反應(yīng)狀態(tài)的現(xiàn)象稱為脊髓休克。

5、1氐滲性缺水Hypotonicdehydration-Losin^morenatriumthanwateratthesametime,

resultinginECFdeficitandhyponatremia.

6、■等滲性缺水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、急性腎衰Acuterenalfailure(ARF)-Asyndromecharacterizedbyarapiddecreaseinthe

abilityofkidneytoeliminatewasteproducts,Clinicallymanifestedbydecreasedurineoutput

andtheaccumulationofthewasteproductsofthemetabolismofnitrogen(ureaandcreatinine)。

11、;肺，心腦復(fù)蘇CardiopulmonarvResuscitation(CPR)-isanemergencyprocedurewhichis

performedinanefforttomanuallypreserveintactbrainfunctionuntilfurthermeasuresare

takentorestorespontaneousbloodcirculationandbreathinginapersonincardiacarresto

12、Intensivecareunit(ICU)-isaspeciallystaffedandequippedhospitalwarddedicatedtothe

managementofpatientswithlife-threateningillnessesjnjuriesorcomplications

13、低氧血Hypoxemiaisdefinedasdecreasedpartialpressureofoxygeninblood,aslessthan

60mmHg(8.0kPa)

14、Oxygentherapyistheadministrationofoxygenasamedicalintervention,byincreasingthe

FiO2(吸入氧濃度)andPAO2(吸入氧分壓),inordertoincreasethePa02(動(dòng)脈血氧分壓)

andeaseorevenrectifythehypoxemia

15、MechanicalVentHation機(jī)械通氣一isamethodtomechanicallyassistorreplace

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

開)

16、心臟驟停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、最小肺泡濃度MAC(minimumalveolarconcentration)…Theequilibriumend-tidal

anestheticconcentrationthatpreventmovementinresponsetosurgicalskinincisionin50%of

humansubjects.

簡答

1、二感染性休克的治療原貝1Treatmentofsepticshock/principlesofsepsisshocktreatment/

休克治療--①FluidreplacementorBloodtransfusiontoincreaseBloodvolume②controlthe

infection:Antibioticsandoperation③Treatacidosis@Vasoactivedrugs⑤Dexamethasone⑥

①迅速補(bǔ)充

Nutrientssupplyetc?preventDICandMODS@Maintainingvitalorgan'sfunctiono

血容量；②控制感染：處理原發(fā)感染灶；應(yīng)用抗菌藥物；改善病人一般情況，增強(qiáng)抵抗力。

③糾正電解質(zhì)和酸堿平衡紊亂；④改善微循環(huán)，應(yīng)用血管活性藥；⑤應(yīng)用糖皮質(zhì)激素；⑥監(jiān)

測重要臟器如心腦腎功能，防治DIC和MODSo

2、感染性休克的臨床表現(xiàn)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、休克的治療HowisShocktherapy—(1)EarlyGoalDirectiveTheranv：①M(fèi)AP265mmHg

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的診斷DiagnosisofSIRS一①Bodvtemperature>38℃,or<36c②Heartrate>90bpm

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

cells>10%

6、二低血鉀的病因和診斷-一(1)Cause：①parenteralnutritionwithinadequatepotassium

replacement,?movementofpotassiumintocells：acidosis,injectionofglucoseandinsulin③

prolongedadministrationofpotassium-freeparenteralfluidswithcontinuedobligatoryrenalloss

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

gastrointestinalsecretions.(2)診斷：血鉀低于3.5mmol/L表示有低鉀血癥。

常見原因有：①長期進(jìn)食不足；②補(bǔ)液病人長期接受不含鉀鹽的液體，或靜脈營養(yǎng)液中鉀鹽

補(bǔ)充不足；③應(yīng)用吠塞米等利尿劑，腎小管性酸中毒，急性腎衰竭多尿期，醛固酮過多，使

鉀從腎排出過多。④嘔吐、持續(xù)胃腸減壓、腸疹等，鉀從腎外途徑喪失；⑤鉀向組織內(nèi)轉(zhuǎn)移，

見于大量輸注葡萄糖和胰島素，或代謝性、呼吸性酸中毒。

7、?高鉀血癥的原因和處理原則一(1)Cause：①overintakeofpotassium②severeinjuryor

surgicalstress③Acidosis④thecatabolicstate,?oliguricoranuricrenalfailure；(2)Treatment:

(Dintravenousadministrationof1gm.of10%calciumgluconateunderECGmonitoring；②

administrationofbicarbonateandglucosewithinsulin(lp/4gG)；③Rapidalkalinizationofthe

ECFwitheithersodiumlactateorbicarbonatepromotestransferofpotassiumintocells；④

definitiveremovalofexcesspotassiumbycation-exchangeresins,peritonealdialysis,or

hemodialysis.

高鉀血癥有導(dǎo)致病人心臟停搏的危險(xiǎn)，一經(jīng)診斷，應(yīng)積極治療，首先應(yīng)立即停用一切含鉀的

藥物或溶液。并采取以下措施以降低血鉀濃度；①促使K+轉(zhuǎn)入細(xì)胞內(nèi)：輸注碳酸氫鈉溶液；

輸注葡萄糖溶液及胰島素；②陽離子交換樹脂的應(yīng)用；③透析療法。

8、外科補(bǔ)鉀注意事項(xiàng)①Nomorethan40mmolshouldbeaddedto1literofintravenousfluid；

②Therateofadministrationshouldnotexceed20mmol/hourunlesstheECGisbeing

monitored.③Administrationofpotassiumisabout3-6g/day；④補(bǔ)鉀應(yīng)在尿量大于40ml/h后

進(jìn)行。(休克未糾正時(shí)先糾正休克再補(bǔ)鉀)；⑤復(fù)查血鉀濃度，注意酸中毒的影響。

9、-水中毒waterintoxication的定義、病因和臨床表現(xiàn)(1)定義：水中毒又稱稀釋性低

血鈉，系指機(jī)體的攝入水總量超過了排出水量，以致水分在體內(nèi)潴留，引起血漿滲透壓下降

和循環(huán)血量增多。(2)病因：①各種原因致抗利尿激素分泌過多;②腎功不全，排尿能力下

降；③機(jī)體攝入水分過多或接受過多的靜脈補(bǔ)液c(3)臨床表現(xiàn)：①急性水中毒發(fā)病急驟,

水過多致腦細(xì)胞腫脹可造成顱內(nèi)壓增高，引起一系列神經(jīng)、精神癥狀，如頭痛、嗜睡、躁動(dòng)、

精神紊亂、定向力障礙、諂妄，甚至昏迷。②慢性水中毒癥狀往往被原發(fā)病癥狀掩蓋。可有

軟弱無力、惡心、嘔吐、嗜睡等。體重明顯減輕，皮膚蒼白而濕潤。

10、■麻醉前準(zhǔn)備/用藥的目的Aimsofpreanestheticpreparation&preanesthetic

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

?Increasethepainthreshold③Inhibitthesecretionofrespiratoryglands④Eliminatethe

harmfulreflexcausedbysurgeryoranesthesia,especiallytheVagalreflex<>

11、?局麻藥毒性反應(yīng)常見原因?一intravascularinjectionandoverdosage,Allergicreactiono

12、全身麻醉的并發(fā)癥及其治療Complicationsandtreatmentsofgeneralanesthesia一①

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

emptying;lowerthePH;Reducestomachinnerpressure;enhancetheprotectionofairway；②

Upperairwayobstruction:opentheairway;eliminatethesecretionandforeignbody;

tracheotomy；③Lowerairwayobstruction:maintainthesuitabledepthofanesthesiaand

oxygenation;intravenousinjectionofaminophylline（氨茶堿）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（高熱）hyperspasmia（抽搐）convulsions（驚厥）:physicalcooling,especially

theheadincaseofencephaledemao

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

block--?Anticoagulanttherapy②Sepsisonskinofback③Hypovolemia④Activebacterialor

virusinfectionsoftheperipheralandcentralnervoussystem.?Elevationofintracranialpressure.

14、蛛網(wǎng)膜下腔麻醉/腰麻的并發(fā)癥Subarachnoidanesthesia（alsocalledlumbaranesthesiaor

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

decreases;Respiratorydepression;Nauseaandvomit?Complicationaftersurgery:Headache;

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

性蛛網(wǎng)膜炎）；Tailplexussyndrome（尾叢綜合征）。

15、硬膜外阻滯的并發(fā)癥Epiduralblock—①Complicationduringsurgery:Totalspinal

anesthesia;Toxinreactionoflocalanesthesia;Fallofbloodpressure;Respiratorydepression;

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

腫）;Epiduralabscess;Spinalanteriorarterysyndrome（脊柱前動(dòng)脈綜合征）。

16、硬膜外麻醉的適應(yīng)癥--頸部以下的，非開胸的手術(shù)。

17、ICU的納入條件WhocanbeadmittedtotheICU--①Trauma&Majorsurgery?

Monitoringafterorgantransplant③Circulationdecompensation?Havepotentialofrespiratory

failureandneedrespiratortreatment?Severedisturbanceofwaterandelectrolyteand

acid-baseimbalance⑥AnestheticaccidentorafterCPR⑦Singleormultipleorgandysfunction?

Severemetabolicdisorderso

18、氧療的指征OxygentherapyindicationCardiacandrespiratoryarrest;Respiratoryfailure

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

states'Carbonmonoxidepoisoning

19、心臟驟停的原因Commoncausesofcardiacarrest?Primary:Suddencessationofheat

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

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

Temperatureextremes;Toxins;Acuteanaphylaxiso

20、心肺腦復(fù)蘇的標(biāo)準(zhǔn)過程StandardprogrammingofCPCR-iA(AssessmentandAirway)

神志判定與暢通氣道B(Breathing)人工呼吸C(Circulation)重建循環(huán)D(Drugsandfluids)

藥物與輸液E(ECG)心電圖F(Fibrillationtreatment)電除顫G(Gauging)評(píng)估H(Human

mentation)恢復(fù)神志I(Intensivecare)重癥監(jiān)護(hù)

21、初期心肺復(fù)蘇的三個(gè)步驟，心臟擠壓的有效標(biāo)志--1Aairway(開放氣道)Bbreathing(人

工呼吸)Ccirculation(胸外心臟按壓建立人工循環(huán))2有效標(biāo)志是:①大動(dòng)脈處可捫及波動(dòng)

②紫綃消失,皮膚轉(zhuǎn)為紅潤③可測得血壓。

22、觸電致心跳呼吸停止，徒手搶救的措施-一(1)保持呼吸道暢通Airway：頭后仰，托起

下頜；(2)人工呼吸Breath：①口對口人工呼吸，一手捏患者鼻子,使其頭后仰托起下頜，深

吸一口氣口對口緩慢吹起，使患者胸廓隆起，離開患者口，放開鼻子，患者肺內(nèi)氣體呼出②口對

鼻人工呼吸,將患者口捏住,從鼻子吹起，其他同上；(3)胸外心臟按壓Circulation：患者仰

臥于地板上，搶救者跪于患者一側(cè)雙手交叉，雙臂伸直，手掌壓在患者胸骨中下1/3交界處，

垂直下壓3~4cm,立即放松，放松時(shí)手掌不離開胸壁，擠壓與放松時(shí)間相等，頻率60-80次/

分(或80~100次/分)，一人搶救時(shí)，每擠壓心臟15次行人工呼吸2次；如果倆人搶救，每

擠壓心臟5次，行人工呼吸1次，直至患者心跳呼吸恢復(fù)或救護(hù)車到來。

23、氣管插管分類■一①根據(jù)插管途徑分:經(jīng)口腔插管，經(jīng)鼻腔插管，經(jīng)氣管造口插管;②根據(jù)聲

門是否暴露:明視插管法,盲插插管法；③根據(jù)病人是否清醒:清醒氣管插管、誘導(dǎo)氣管插管:

保持自主呼吸插管無自主呼吸插管。

第一章總論感染、創(chuàng)傷燒傷凍傷、器官移植、顯微外科及手外傷

名解

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

procedureoroccursinanoperatedsite.

2、二急性蜂窩織炎Acutecellulitis—acuteinflammationoflooseconnectivetissue,usually

occurssubcutaneously,subfascially,inintermuscularspaceordeepcellulite,mostlycausedby

hemolyticstreptococcus.

3、??丹毒Erysipelasacuteinflammationoflymphaticcapillarynet,mostlycausedbyhemolytic

streptococcus.

4、Superinfection--anewinfectionthatdevelopsduringantibiotictreatmentfororiginal

infectiono

5、Furuncle拜acutesuppurateinfectionofsinglefolliculuspiliwithitsglandulaesebaceae

6、Carbuncle癰--acutesuppurateinfectionofmutiplefolliculuspiliwithitsglandulaesebaceae.

7、Tetanus破傷風(fēng)Adiseasecausedbytetanospasmin,apowerfulproteintoxinproducedby

ClostridiumTetani.Tetanususuallyoccursafteranacuteinjury,suchasapuncturewound.

8、氣性壞疽GasgangreneAclostridialinfectiontypicallyinvolvesunderlyingmuscle,isalso

termedclostridialmyonecrosis.

9、?牽涉痛一某些內(nèi)臟器官病變時(shí),在體表一定區(qū)域產(chǎn)生感覺過敏或疼痛感覺的現(xiàn)象，稱為

牽涉痛。

10、?清創(chuàng)術(shù)debridement一是用外科手術(shù)的方法,清除開放傷口內(nèi)的異物，切除壞死、失活

或嚴(yán)重污染的組織、縫合傷口，使之盡量減少污染，甚至變成清潔傷口，達(dá)到一期愈合，有

利受傷部位的功能和形態(tài)的恢復(fù)。

11、?深2°燒傷DeepSecondDegreeInvolvingdermisthickerthansuperficialone；Heal

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

blister；Needskingraftingo

12、?重度燒傷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、燒傷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、異體移植術(shù)Allotransplantation-Organsortissuesaretransplantedfromadonortoa

geneticallynon-identicalmemberofthesamespecieso

23、異種器官移植Xenotransplantation-Transplantingorgansortissuesfromonespeciesto

another<,

24、熱缺血時(shí)間Warmischemiatime(WIT)—indicatestheperiodfromthestopofbloodsupply

ofdonororgantothebeginningofcoldperfusion,WIT<10minuteso

25、冷缺血時(shí)間Coldischemiatime(GT)…indicatestheperiodfromcoldperfusiontorecovery

ofbloodcirculationofthegrafts,includingthewholepreservationtime。

簡答

1、夕卜科感染的臨床表現(xiàn)ClinicalmanifestationsofSurgicalInfection①localsymptoms:

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

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

symptoms:破傷風(fēng)肌強(qiáng)制性痙攣，氣性壞疽皮下捻發(fā)音，炭疽發(fā)養(yǎng)性黑色膿皰。

2、?非特異物感染的轉(zhuǎn)歸一①炎癥好轉(zhuǎn)②局部化膿③炎癥擴(kuò)展④轉(zhuǎn)為慢性炎癥。

3、■?手部感染的解剖學(xué)特點(diǎn)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、■燒傷的并發(fā)癥一①Pulmonary:moreoften,within2PBW@Renal:shockandinfectionare

maincauses.infectiveRFismorelikenon-oliguric③Cardiac:shockheart:shockandinfection,

payattentiontocardiacprotection④Stressulcer:applicationofantacid⑤Cerebraledema。

5、燒傷性休克的液體復(fù)蘇Fluidresuscitationofburnshock…?TMMUformula:①Fluidinfusion

during1st24hours:0.5mlcolloidand1mlelectrolytesperkgofbodyweightevery1%IIor

IIIdegreeTBSAinadults,withadditional2000mlwater(5%glucose).Halfofthetotalamount

wasinfusedduringthefirst8PBHs,whiletheotherhalfwasinfusedatthelatter16PBHs；②

Fluidamountduringthe2nd24PBHs:Halfoftheelectrolytesandcolloidinfusedpracticalinthe

1st24PBHs.Withthewater2000ml.③Noupperlimitforthefluidinfusion.Andthosewith

morethan50%TBSAshouldreceivefluidaccordingly.

第一個(gè)24小時(shí)，每1%燒傷面積(2、3度)每公斤體重應(yīng)補(bǔ)膠體和電解質(zhì)液共1.5ml(小

兒2.0ml)o膠體(血漿)和電解質(zhì)(平衡鹽液)的比例為0.5:1,廣泛深度燒傷者與小兒

燒傷者其比例可改為0.75:0.75.另加以5%葡萄糖溶液補(bǔ)充水分2000ml(小兒另按年齡、

體重計(jì)算)，總量的一半應(yīng)于傷后8小時(shí)輸入。第二個(gè)24小時(shí)，膠體和電解質(zhì)為第

一個(gè)24小時(shí)的一半，水分補(bǔ)充仍為2000mlo

舉例：燒傷面積60%、體重50KG病人，第一個(gè)24小時(shí)補(bǔ)液補(bǔ)液總量為：

60*50*1.5+2000=6500ml,其中膠體為60*50*0.5=1500ml,電解質(zhì)液為60*50*l=3000ml,

水分2000mlo

6、?外科手術(shù)洗手穿手術(shù)衣后的無菌范圍-一背部、腰部以下和肩部以上部位為有菌地帶。

7、甲溝炎的臨床表現(xiàn)Paronychiaclinicalmanifestation一一①Usuallyhappeninsubcutaneous

tissueofnailgrooveofonesideinearlystage.Redness,swellingandpain.②Fluctuationoccurs

asprogressing,whitepusspotsbutnoteasilyulcer.③Canspreadtooppositeside@Pusunder

nail.Progresstowhitlowandevenconstitutionalsymptoms.

8、全身性外科感染的臨床表現(xiàn)一A.suddenonsetoffever,40-41°,orhypothermia,progress

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

tachycardia,weakandrapidpulse,dyspnea.D.HepatosplenomegalyzjaundiceandSubcutaneous

petechiaeo

9、總體表面積的劃分TotalBodySurfaceAreaTBSA(9method)--3head,3face,3neck,5

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

crus,21thigho

10、燒傷的治療原貝!1Treatmentprincipleofburntrauma—(L)Mild：debridement,wound

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

shock②Earlycutofsevereburnedtissue,autologousorallogenicskintransplant③Modify

shock,controlinflammationincaseofMODS④Payattentiontotherecoveryofmorphologyand

functiono

11、創(chuàng)傷的并發(fā)癥Complicationoftrauma?一①nfection；②Shock；@Fatembolismsyndrome

FES；?Stressulcer；?Coagulationdysfunction；?Organdysfunctiono

12、手燒傷的治療原則Manageprincipleofhandbum--??(SuperficialIIdegree,exposureor

bandage,handsinfunctionpositionwhenbandage；②Earlytangentialexcisionorescharectomy

andskingraftingwithlargesheetautosplitskin；?Circumferentialescharofwristandfingers,

earlyescharotomyo

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

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

14、手部傷的治療原貝!]Basicprinciplesoftreatmentofhandinjury-①Bleedingcontroland

preventfurthercontamination?Carefulassessmentsofinjuryandallstructures③Debridement

in6-8h④Trytorepairallstructuresintheprimaryphase⑤Trytoclosethewoundintheprimary

phase?correctaftercareandhandimmobilizationinfunctionpositiono

15、病例一男性青年不慎跌入水溫近100C水池中。傷后即急診入院救治。體檢:體重60

公斤，神情，但面色蒼白，脈搏快、弱，雙下肢、會(huì)陰部布滿水泡，背部均起紅斑。請分析并試述:

①該傷者燒傷面積是多少？屬燒傷嚴(yán)重度哪一類？②傷后24小時(shí)的補(bǔ)液量，種類和方法。③

臨床調(diào)節(jié)補(bǔ)液速度最簡便實(shí)用的監(jiān)測指標(biāo)是什么？

答：①(三三三五六七，十三十三二十一，雙臀占五會(huì)陰一，小腿十三雙足七)或(3,33；

5,6,7,；5,7,13,21,；13,13,1)燒傷面積是47%,II度，屬重度燒傷

②第1個(gè)24小時(shí)補(bǔ)液量(其中晶膠體可用2:1或1:1方案)47(60)*1.5*60體重+2000生

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

膠體1410(2467)毫升，葡萄糖液2000毫升

補(bǔ)液方法:傷后8小時(shí)滲出迅速，使血容量減少，故第1個(gè)24小時(shí)額外損失量的1/2應(yīng)在傷后

8小時(shí)內(nèi)補(bǔ)入體內(nèi)。其余量在傷后16小時(shí)均勻輸入。

補(bǔ)液種類:晶體液用平衡鹽液或等滲鹽水，膠體用血漿或低分子右旋糖酊③每小時(shí)尿量尿量達(dá)

40ml/h時(shí)才能補(bǔ)鉀④口服者盡量改為口

第二章頭頸部

名解

1、=繼發(fā)性腦損傷seconderybraininjury—Delayedbraintissuepathologicalchangesoccur

afterinjury,mainlybrainedemaandintracranialhematoma.

2、二顱內(nèi)壓升高Raisedintracranialpressure-aclinicalpathogenicsyndromeresultsformthe

continuouslyincreasedintracranialpressionupto2.0kPa(200mmH20)andenlargementofthe

cranialcavitycontentwhichusuallycausedbythecraniocerebralinjure,braintumor;

hematencephalon,hydrocephalusandinflammation。

3、二二中間清醒期Lucidinterval-Whenprimaryinjuryismild,comausuallylastsshortly.When

hematomaformationisnotrapidenough,thereisatimeintervalbetweencomacausedby

primaryinjuryandsecondarycomacausedbybrainhernia,duringwhichthepatientisoften

conscious.Itusuallylastsforhours.

4、腦疝Brainhernia-Braintissueshiftsthroughrigidopeningsofskull(suchasthefalx

cerebri(大腦鐮)，thetentoriumcerebelli(小腦幕),andtheforamenmagnum),compressother

structuresofthebrainandproducingtheobservedsyndromeso

5、小腦幕切跡疝UncalHerniation--uncusoftemporallobeherniatesdownthroughtentorial

notcho

6、枕骨大孔疝TonsillarHerniation--cerebellartonsilsherniatethroughforamenmagnum。

7、==Langlitt曲線/體積壓力反應(yīng)Volume?PressureResponse—如果原有的顱內(nèi)壓增高已超過

臨界點(diǎn)，釋放少量腦脊液既可使顱內(nèi)壓明顯下降，若顱內(nèi)壓增高處于代償?shù)姆秶鷥?nèi)，釋放少

量腦脊液僅引起微小的壓力下降。

8、==Cushing反應(yīng)一顱內(nèi)壓急劇增高時(shí),病人出現(xiàn)血壓升高、心跳和脈搏緩慢、呼吸節(jié)律紊

亂及體溫升高等各項(xiàng)生命體征發(fā)生變化。

9、==顱內(nèi)壓增高"三主征"一①Headache②Vomiting③Papilledema。

10、==熊貓眼征Raccooneves——Generalizedeperiorbitalcchymosisandnosebleedinfractureof

anteriorcranialfossa,whichlookslikepanda'seyes.

11、==Battle征…Ecchymosisinthepostauriculararea,happenedinfractureofposteriorcranial

fossa.

12、==腦震蕩CerebralconcussionTransientneuraldisorder,Nosigns,CT(-),Nogross

pathologicalfindings,Neurofibersdisturbedinmicroscope.

13、==原發(fā)性腦干損傷Primarybrainsteminjury-Unstablevitalsigns,Deepcoma,instantly,

constantly,Changeofbrainstemreactions,Nobrainherniation,Diffuseaxonalinjury.

14、==遲發(fā)性外傷性顱內(nèi)血腫Delayedtraumaticintracranialhematoma-Thefirstposttrauma

CTscandetectsnohematoma,butcanbefoundinlaterCT,ornewhematomaoccurswhere

thereisnohematomapreviously.

15、腦挫裂傷Cerebralcontusion--主要發(fā)生于大腦皮層的損傷。

16、逆行性遺忘Retrogradeamnesia-Patientswithcerebralconcussioncannotrecallthe

conditionwhentheinjuryoccursandevenconditionspriortothetrauma.

簡答

1、??顱內(nèi)壓增高癥狀一①Headache②Vomiting③Papilledema④Disturbanceofconsciousness

andchangesofvitalsigns⑤Others。

2、?顱內(nèi)壓增高原因Reasonsofincreasedintracranialpressure——①EnlarRementofthecranial

cavitycontent.Suchasthevolumeofbraintissueenlargement(encephaledema),CSF

increases(hydrocephalus),backflowobstructionoroverinfusionofcerebralveins,bloodvolume

increases.②Intracranialspacerelativelydecreasescausedbythespace-occupyinglesion.Suchas

hematoma,tumor,abscess③Intracranialspacedecreasescausedbycongenitalmalformation.

Suchascraniostenosis(狹顱癥

3、==顱內(nèi)壓升高的治療原則一(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、顱內(nèi)壓升高的后果Consequenceofincreasedintracranialpressure■一?Decreasedcerebral

bloodflow,ischemia,braindeath②Brainshiftandcerebralhernia③Encephaledema④Cushing

reaction⑤Gastrointestinaldysfunctionandalimentarybleeding⑥Neurogenicpneumonedemao

5、?<］、腦幕切跡疝I臨床表現(xiàn)transtentorialhernia(alsocalledtemporallobehernia)一一①

Symptomsofincreasedintracranialpressure:progressivesevereheadachecompanieswithfidget,

frequentvomiting；②ChangeofpupH:earlystage(myosis,decreasedordisappearedoflight

reflex);latestage(mydriasis,disappearedoflightreflex)；③Dyskinesia運(yùn)動(dòng)障礙:decreasedor

paralyticmu