急性腹痛的治疗

Acute Abdominal Pain

急腹症

　　Definition

　　说明

　　Causes of acute abdominal pain are varied. Although sometimes called "surgical" abdomen, acute abdominal pain does not always necessitate surgery. Many disorders must be ruled out before a diagnosis is confirmed.

　　急腹症的原因很多。虽然它有时也被称为"手术"症，但急腹症并不是都必须做手术。有些情况在诊断确认前就必须得以排除。

　　Clinical Manifestations

　　临床症状

　　Pain is the most important symptom of acute abdominal pain. A patient may also complain of abdominal tenderness, vomiting, diarrhea, constipation, flatulence, fatigue, and an increase in abdominal girth.

　　疼痛是急腹症的最重要症状。病人主诉也可以包括腹部压痛、呕吐、腹泻、便秘、气胀、疲劳及腰围增大等。

　　Diagnostic Studies

　　Diagnosis begins with a complete health history and physical examination. Physical examination should include both a rectal and a pelvic examination.

　　Complete blood count （CBC）, urinalysis, abdominal x-ray examination, and an ECG are done initially.

　　A pregnancy test should be performed on a woman of childbearing age who has acute abdominal pain.

　　诊断检查

　　首先进行完整的健康史和体格检查，包括直肠和盆腔检查。

　　血尿常规、腹部X片、心电图。

　　育龄期妇女出现急腹症时应行妊娠试验。

　　Therapeutic Management

　　治疗

　　The goal of therapeutic management is to identify and treat the cause. A differential diagnosis needs to be made because many causes of abdominal pain do not require surgery.

　　In addition to being a therapeutic measure, surgery can be diagnostic. Operative exploration is usually done after careful examination of the patient, and it is justified when "look and see" is better than "wait and see."

　　治疗目的是对病因进行识别和治疗。由于很多腹痛病因并不需要手术，因此，必须进行鉴别诊断。

　　除了治疗外，手术也可以是一各诊断手段。通常，在对病人作仔细检查后，也可以作手术检查，尤其是在"检查观察"比"静候观察"更为有利的情况下，手术检查无疑更为合理。

　　Nursing Management

　　护理

　　An exploratory laparotomy in which an opening is made through the abdominal wall into the peritoneal cavity is done to detemine the cause of an acute abdomen. If the cause of acute abdomen can be surgically removed （e.g., inflamed appendix） or surgically repaired （e.g., ruptured abdominal aneurysm）, then surgery is considered definitive therapy.

　　剖腹探查就是经由腹壁开口观察腹膜腔，以确定急腹症的病因。如病因可以通过手术排除（如阑尾炎）或通过手术修复（如腹部动脉瘤破裂），便可以考虑手术是最后的治疗方法。

　　Goals

　　护理目标

　　The patient will have a satisfactory level of pain control, relief of nausea and vomiting, normal bowel sounds within 72 hours, absence of fever, and lungs clear to auscultation.

　　病人对疼痛控制、恶心呕吐缓解感到满意，72小时内肠鸣音正常，不发烧，肺部听诊无杂音。

　　Nursing Diagnoses

　　护理诊断

　　Pain: related to surgical incision and inadequate pain control measures

　　Nausea and vomiting: related to decreased GI motility, GI distention, and narcotics

　　Ineffective airway clearance: related to effects of anesthesia, sedation, pain, immobility, and location of incision

　　Constipation: related to immobility, pain, medication, and decreased motility

　　疼痛：与手术切口和疼痛控制措施不当有关

　　恶心呕吐：与胃肠运动减少、胃肠膨胀及麻醉药品使用有关

　　气道清理无效：与麻醉效果、镇静作用、疼痛、活动不能及切口部位有关

　　便秘：与活动不能、疼痛、用药及运动减少有关

　　Nursing Interventions

　　护理措施

　　1.General care for the patient involves management of fluid and electrolyte imbalances, pain, and anxiety. Preoperative preparation of a patient with an acute abdomen includes a CBC count, typing and crossmatching of blood, and clotting studies. Catheterization, preparation of abdominal skin, and passage of a nasogastric （NG） tube may be done in the emergency department or operating room （OR）.

　　病人一般护理措施包括液体电解质紊乱、疼痛和焦虑症的处理。急腹症病人术前准备包括CBC计数、血型和交叉配血、凝血化验。插管、腹部皮肤准备及鼻胃管可在急诊室或手术室进行。

　　2.Increased use of laparoscopic procedures has reduced the risk of postoperative complications related to wound care and altered GI motility. These procedures generally result in shorter hospital stays.

　　腹腔镜检查减少了发生与伤口护理和胃肠道运动减少相关的术后并发症的危险，可以缩短住院时间。

　　3.If an NG tube is present, it is connected to suction as ordered. The purpose of this tube is to empty the stomach of secretions and gas to prevent gastric dilatation. The NG tube is checked frequently for patency because it may become obstructed with mucus, sediment, or old blood. An order is usually written to irrigate the tube with 20 to 30 ml of normal saline solution if needed. Repositioning the tube may facilitate drainage. Mouth care and nasal care are essential.

　　如果使用鼻胃插管，应遵医嘱与抽吸管相连。毛鼻胃插管的目的是排空胃部分泌物和气体，防止胃扩张。鉴于粘液、渣滓或殘血可能造成堵塞，应经常检查鼻胃管是否通畅。护嘱中通常写明，必要时用20至30 ml生理盐水冲洗插管。重新插管有助于引流，还必须施行口腔护理和鼻部护理。

　　4.Parenteral fluids are administered to provide the patient with fluids and electrolytes until bowel sounds return. Occasionally, ice chips may be ordered because they relieve a dry mouth.

　　在肠鸣音恢复前，非肠道补液可为病人体内液体和电解质。有时可在护嘱中使用冰棒，他们可以起到缓解口干的作用。

　　5.Although nausea and vomiting are not uncommon after abdominal surgery, these problems are often self-limiting. Observation is important in determining the cause. Antiemetics such as promethazine, prochlorperazine, or trimethobenzamide may be ordered.

　　尽管腹部手术后恶心呕吐并不常见，即使出现也常常是可以自己控制的。重要是要通过观察确定其原因。也可以开一些止吐药，如异丙嗪、丙氯拉嗪）或曲美苄胺等。

　　6.Abdominal distention and gas pains are also common after a laparotomy; they are due to swallowed air and impaired peristalsis resulting from immobility, manipulation of abdominal contents during surgery, and side effects of anesthesia. The resulting pain can be so uncomfortable that medications to stimulate peristalsis, such as bethanechol or neostigmine methylsulfate, may be given. A rectal tube or moist heat on the abdomen may be effective in relieving distention. The physician should be informed of abdominal distention and rigidity. As intestinal activity increases, distention and gas pains gradually decrease.

　　剖腹术后出现腹用及腹痛也是常见的症状，这是由吞咽空气及运动不能引起肠蠕动受损、手术期间腹内容物处理、麻醉副作用等造成的。由此造成的疼痛的会很难受，可以给些药物刺激胃肠蠕动，如氨甲酰甲胆碱或甲硫酸新斯的明等。肛管或腹部湿热敷可有效缓解腹胀。如出现腹胀和腹部强直，就通知医生。因为随着肠动增加，腹胀和胀痛也会逐渐增加。

　　7.Emotional support from the nursing staff is important. Honest, clear, concise explanations of all procedures in language the patient and family can understand will assist in allaying anxiety.

　　护理人员有情感支持也很重要，用病人及亲属能够理解的语言诚实、清楚、精简地说明操作程序可以帮助减轻病人的焦虑。

　　Patient Teaching

　　病人宣教

　　1.Patient teaching for discharge begins when the patient returns from the OR. Instructions to the patient and family should include any modifications in activity, care of the incision, diet, and drug therapy.

　　在病人从手术室返回时就应开始病人出院宣教。病人及亲属指导内容包括运动限制、切口护理、饮食和用药等。

　　2.Small, frequent meals that are high in calories should be taken initially, with a gradual increase in food intake as tolerated.

　　开始时可少量多餐，食用一些高卡食物，在许可情况下再逐渐增加摄食量。

　　3.Normal activities should be resumed gradually with planned rest periods.

　　应逐渐恢复正常运动，并规定休息时间。

　　4.The patient should be aware of possible complications after surgery and should notify the physician immediately if vomitting, pain, weight loss, incisional drainage, or changes in bowel function occur.

　　病人应了解可能的术后并发症，应在出现下列情况时应立即通知医生：呕吐、疼痛、体重下降、切口渗液或肠道功能发生变化。