7. 急性腹泻
概 述
腹泻是常见的急诊症状之一。尽管腹泻的病因很多,但85%的病例与感染有关。大多数腹泻是自限性的,只需加强护理和对症治疗。感染性腹泻可引起严重后果,特别是在易感人群,可导致大规模发病,甚至死亡。非感染性腹泻同样可以对健康人和患者造成巨大威胁。腹泻可以是腹部疾病,也可以是内分泌疾病、中毒以及其他系统疾病的临床表现之一,因此只有在广泛考虑或排除其他病因之后才能诊断胃肠炎或病毒性腹泻。以下是急性腹泻诊治的临床路径。
表7.1 腹泻的重点评估
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T7.1_5892.jpg?sign=1739664153-XsoB2POiqBPnZ5amatCxPWh2bFNhxU8C-0-82a6869b0602f542cc6ceeaac9633f59)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T7.1_1_5946.jpg?sign=1739664153-CKfOQmiVJeXtEIiVMs7Ilc37jyoQPIBv-0-a6f77385a5d2830a8ebb3844295ecb2e)
注:HIV阳性患者腹泻
表7.2 急性严重腹泻的急诊检查
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T7.2_5954.jpg?sign=1739664153-W9ZHMY1rGs9dJn0WejaBcXymGAHDdm7Z-0-31583940b5b315a5ffb5630aca64fcf2)
表7.3 社区获得性腹泻
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T7.3_59950.jpg?sign=1739664153-5VbWshG06rElYdVabA4XF73rRUgaDFjW-0-648ac885ee4b5826da8e9bd3fa05abe0)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T7.3_1_59951.jpg?sign=1739664153-HHetNGPssbpkrtaqIfdaiHX8wHVlZGEQ-0-d5a8b5a2d5415b48f306f669eaa46440)
表7.4 医院获得性腹泻
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T7.4_59952.jpg?sign=1739664153-MMVpN8AsHduj7S01tZXOSTTvJRWRQixs-0-3d2b0b6ee5d3acdf6861adaeaee78e8a)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T7.4_1_59953.jpg?sign=1739664153-giENzFy0jpUTC52mX5MoHgl32Vw023ZC-0-8f187f4037bab11d217c0372a5060cda)
表7.5 旅行后腹泻
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T7.5_59954.jpg?sign=1739664153-htkC0p8s3VvnMpHhP57j4oXHXyZNmkTf-0-67a97360df523f8a7ae9d45e07e7a973)