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上消化道出血量怎么估计？怎么判断活动性出血 ？

2016-03-21 佚名 医学之声

上消化道出血活动性出血
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1.上消化道出血量估计5-10ml  大便隐血(+)60-100ml  黑粪250-300ml  呕血<400ml  可代偿无症状700-800ml   全身乏力、眩晕口渴、畏寒、血压下降1500ml以上  出血性休克、烦躁不安、意识不清、面色苍白、四肢湿冷、口渴冷汗、血压下降(收<80mmHg)，脉压<30mmHg 脉

1.上消化道出血量估计

5-10ml  大便隐血(+)
60-100ml  黑粪
250-300ml  呕血
<400ml  可代偿无症状
700-800ml   全身乏力、眩晕口渴、畏寒、血压下降
1500ml以上  出血性休克、烦躁不安、意识不清、面色苍白、四肢湿冷、口渴冷汗、血压下降(收<80mmHg)，脉压<30mmHg 脉博细数(>120次/min)

出血后症状和体征的改变与出血量、速度均有关
大便潜血（+）出血量>5ml/天
柏油样便 >60ml/天
呕血、胃内积血>250-300ml

2.活动性出血征象

1.患者又有失血症状
2.呕血或黑便变稀、次数增多
3.肠鸣音活跃
4.血压、脉搏经治疗无改善或恶化
5.Hb、HCT持续下降
6.中心静脉压波动不稳定
7.如不能确定，可插胃管观察，或行急诊内镜检查

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  1. 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createdName=1de304d2m86(暂无匿称), createdTime=Tue Mar 22 12:57:00 CST 2016, time=2016-03-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=72549, encodeId=9263e25496e, content=不错，收藏了, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3wX2G6elNRPKfNx9ZncyrF3PLdiaO0ua9zmSwUV0gyyNQhoG3ObEqbruynTicFKTDNAbYdlgjqS6UbT80ricnV8zgO/0, createdBy=47021668212, createdName=hbjxgrp1213, createdTime=Tue Mar 22 07:58:00 CST 2016, time=2016-03-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=72544, encodeId=1d33e254444, content=经典必须记忆, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2d331664955, createdName=老段, createdTime=Tue Mar 22 07:56:00 CST 2016, time=2016-03-22, status=1, ipAttribution=)]
    2016-05-11 楚秀娟

    #活动性#

    0

  2. 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createdName=1de304d2m86(暂无匿称), createdTime=Tue Mar 22 12:57:00 CST 2016, time=2016-03-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=72549, encodeId=9263e25496e, content=不错，收藏了, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3wX2G6elNRPKfNx9ZncyrF3PLdiaO0ua9zmSwUV0gyyNQhoG3ObEqbruynTicFKTDNAbYdlgjqS6UbT80ricnV8zgO/0, createdBy=47021668212, createdName=hbjxgrp1213, createdTime=Tue Mar 22 07:58:00 CST 2016, time=2016-03-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=72544, encodeId=1d33e254444, content=经典必须记忆, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2d331664955, createdName=老段, createdTime=Tue Mar 22 07:56:00 CST 2016, time=2016-03-22, status=1, ipAttribution=)]
    2017-01-04 zchen

    #上消化道#

    0

  3. 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Mar 22 07:56:00 CST 2016, time=2016-03-22, status=1, ipAttribution=)]
    2016-09-09 limedical1986

    #出血量#

    0

  4. 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createdName=1de304d2m86(暂无匿称), createdTime=Tue Mar 22 12:57:00 CST 2016, time=2016-03-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=72549, encodeId=9263e25496e, content=不错，收藏了, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3wX2G6elNRPKfNx9ZncyrF3PLdiaO0ua9zmSwUV0gyyNQhoG3ObEqbruynTicFKTDNAbYdlgjqS6UbT80ricnV8zgO/0, createdBy=47021668212, createdName=hbjxgrp1213, createdTime=Tue Mar 22 07:58:00 CST 2016, time=2016-03-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=72544, encodeId=1d33e254444, content=经典必须记忆, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2d331664955, createdName=老段, createdTime=Tue Mar 22 07:56:00 CST 2016, time=2016-03-22, status=1, ipAttribution=)]
    2016-03-23 医者仁心

    #消化道#

    0

  5. 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createdName=1de304d2m86(暂无匿称), createdTime=Tue Mar 22 12:57:00 CST 2016, time=2016-03-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=72549, encodeId=9263e25496e, content=不错，收藏了, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3wX2G6elNRPKfNx9ZncyrF3PLdiaO0ua9zmSwUV0gyyNQhoG3ObEqbruynTicFKTDNAbYdlgjqS6UbT80ricnV8zgO/0, createdBy=47021668212, createdName=hbjxgrp1213, createdTime=Tue Mar 22 07:58:00 CST 2016, time=2016-03-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=72544, encodeId=1d33e254444, content=经典必须记忆, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2d331664955, createdName=老段, createdTime=Tue Mar 22 07:56:00 CST 2016, time=2016-03-22, status=1, ipAttribution=)]
    2016-03-23 壹生

    口干是出血量大的一个重要症状

    0

  6. 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createdName=1de304d2m86(暂无匿称), createdTime=Tue Mar 22 12:57:00 CST 2016, time=2016-03-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=72549, encodeId=9263e25496e, content=不错，收藏了, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3wX2G6elNRPKfNx9ZncyrF3PLdiaO0ua9zmSwUV0gyyNQhoG3ObEqbruynTicFKTDNAbYdlgjqS6UbT80ricnV8zgO/0, createdBy=47021668212, createdName=hbjxgrp1213, createdTime=Tue Mar 22 07:58:00 CST 2016, time=2016-03-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=72544, encodeId=1d33e254444, content=经典必须记忆, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2d331664955, createdName=老段, createdTime=Tue Mar 22 07:56:00 CST 2016, time=2016-03-22, status=1, ipAttribution=)]
    2016-03-23 壹生

    要记住

    0

  7. 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createdName=1de304d2m86(暂无匿称), createdTime=Tue Mar 22 12:57:00 CST 2016, time=2016-03-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=72549, encodeId=9263e25496e, content=不错，收藏了, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3wX2G6elNRPKfNx9ZncyrF3PLdiaO0ua9zmSwUV0gyyNQhoG3ObEqbruynTicFKTDNAbYdlgjqS6UbT80ricnV8zgO/0, createdBy=47021668212, createdName=hbjxgrp1213, createdTime=Tue Mar 22 07:58:00 CST 2016, time=2016-03-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=72544, encodeId=1d33e254444, content=经典必须记忆, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2d331664955, createdName=老段, createdTime=Tue Mar 22 07:56:00 CST 2016, time=2016-03-22, status=1, ipAttribution=)]
    2016-03-23 1de4b7d2m31(暂无匿称)

    临床上在内消化出血还真多，在我们农村碰到好几例大出血休克病例，否亏抢救转运及时

    0

  8. 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createdName=1de304d2m86(暂无匿称), createdTime=Tue Mar 22 12:57:00 CST 2016, time=2016-03-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=72549, encodeId=9263e25496e, content=不错，收藏了, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3wX2G6elNRPKfNx9ZncyrF3PLdiaO0ua9zmSwUV0gyyNQhoG3ObEqbruynTicFKTDNAbYdlgjqS6UbT80ricnV8zgO/0, createdBy=47021668212, createdName=hbjxgrp1213, createdTime=Tue Mar 22 07:58:00 CST 2016, time=2016-03-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=72544, encodeId=1d33e254444, content=经典必须记忆, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2d331664955, createdName=老段, createdTime=Tue Mar 22 07:56:00 CST 2016, time=2016-03-22, status=1, ipAttribution=)]
    2016-03-22 1de304d2m86(暂无匿称)

    值得学习

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1723899, encodeId=1c0a1e2389900, content=<a href='/topic/show?id=2d996516e7c' target=_blank style='color:#2F92EE;'>#活动性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65167, encryptionId=2d996516e7c, topicName=活动性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=596833562866, createdName=楚秀娟, createdTime=Wed May 11 01:00:00 CST 2016, time=2016-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1723040, encodeId=3ce71e2304072, content=<a href='/topic/show?id=0cc01998259' target=_blank style='color:#2F92EE;'>#上消化道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=19982, encryptionId=0cc01998259, topicName=上消化道)], attachment=null, authenticateStatus=null, createdAvatar=null, 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createdName=1de304d2m86(暂无匿称), createdTime=Tue Mar 22 12:57:00 CST 2016, time=2016-03-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=72549, encodeId=9263e25496e, content=不错，收藏了, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3wX2G6elNRPKfNx9ZncyrF3PLdiaO0ua9zmSwUV0gyyNQhoG3ObEqbruynTicFKTDNAbYdlgjqS6UbT80ricnV8zgO/0, createdBy=47021668212, createdName=hbjxgrp1213, createdTime=Tue Mar 22 07:58:00 CST 2016, time=2016-03-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=72544, encodeId=1d33e254444, content=经典必须记忆, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2d331664955, createdName=老段, createdTime=Tue Mar 22 07:56:00 CST 2016, time=2016-03-22, status=1, ipAttribution=)]
    2016-03-22 hbjxgrp1213

    不错，收藏了

    0

  10. 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createdName=1de304d2m86(暂无匿称), createdTime=Tue Mar 22 12:57:00 CST 2016, time=2016-03-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=72549, encodeId=9263e25496e, content=不错，收藏了, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3wX2G6elNRPKfNx9ZncyrF3PLdiaO0ua9zmSwUV0gyyNQhoG3ObEqbruynTicFKTDNAbYdlgjqS6UbT80ricnV8zgO/0, createdBy=47021668212, createdName=hbjxgrp1213, createdTime=Tue Mar 22 07:58:00 CST 2016, time=2016-03-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=72544, encodeId=1d33e254444, content=经典必须记忆, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2d331664955, createdName=老段, createdTime=Tue Mar 22 07:56:00 CST 2016, time=2016-03-22, status=1, ipAttribution=)]
    2016-03-22 老段

    经典必须记忆

    0

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