5. 急性呕吐
概 述
呕吐原意是指恶心而吐出胃内容物。其定义是指胃内容物或部分肠内容物,通过食管逆流出口腔的一种复杂的动作,常伴有强力的腹肌收缩。呕吐按发展过程将其分为两个阶段:呕吐前期和呕吐期。呕吐前期又称前驱期,以恶心感为主要特征,主要表现为从咽部到胃部先感到一阵特有的不适感,常伴有交感神经兴奋。如进一步发展则进入呕吐期,吐出胃内容物。呕吐过程是靠众多平滑肌和躯体肌肉相互协调、持续收缩完成的。以下是急性呕吐诊治的临床路径。
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/P31_551_1161_1682_2454_4782.jpg?sign=1739664126-8fFkuVKXbKW25jR56qOCF1eB2dYm7wWt-0-d4d95329669473b61ad8796272ec304f)
注意:如果患者在医院内发生急性呕吐,病因通常为肠梗阻或者药物
表5.1 恶心和呕吐的药物治疗
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T5.1_59947.jpg?sign=1739664126-QydnErCYuOvLXCany2wQ0fNYB1mR4WRO-0-56d0a3e681c81ba42bd441b55af85c79)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T5.1_1_59948.jpg?sign=1739664126-fwvKwFom4B81vMn8ZnF1Mxz6n38N0pnG-0-77553068f23c7324b68b447662ecaeee)
注:如果患者在医院内发生急性呕吐,病因通常为肠梗阻或者药物
表5.2 紧急调查
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T5.2_5134.jpg?sign=1739664126-eRvSQs57rTmd7HV4fhf5kuQIuZlZihRN-0-1069697d4016ceba5a389717e7a21aad)
表5.3 急性呕吐的病因
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T5.3_59620.jpg?sign=1739664126-n0gN3tkRCanzzTJaAT5GsdGiMX5qWhhE-0-30a9a1b843dce61d6844e214b50208bd)
表5.4 液体复苏
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T5.4_5200.jpg?sign=1739664126-mQAIasuVJs3bWrLMcGtQtXgNGXneVe8W-0-56fd09fa63ed6d54ee426138bef7487b)
表5.5 初始抗生素治疗
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T5.5_59949.jpg?sign=1739664126-lePgnz8tBwICeIkeb9jSuKIhivyzEXip-0-e9071f1b6380c157aa5a07c668408da2)
表5.6 青霉素过敏
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T5.6_5240.jpg?sign=1739664126-nS8L0VmQNtDpG9LvwaOgWR3jOedKiJLp-0-e35d07a7706d920d2445a588b71dcf39)