子宫破裂的护理课件.ppt

,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,*,.,LOGO,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,.,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,.,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,.,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,.,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,.,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,.,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,.,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,.,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,.,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,.,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,.,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,.,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,.,*,子宫破裂的识别及护理,内容,子宫破裂的概述,1,2,3,子宫破裂的病因及临床表现,子宫破裂的护理,2,.,子宫破裂,定义：是指在分娩期或妊娠晚期子宫体部或子宫下段发生破裂，直接威胁产妇及胎儿生命，是产科极危重的并发症。,国外报道其发生率为,0,8,一,0.05(I,：,1235,1,：,18500),，国内报道发生率为分娩总数的,l,1000,l,16000,。,概述,3,.,分类,发生原因：自发性破裂、,损伤性破裂,发生部位：子宫体破裂,子宫下段破裂,破裂程度：完全性破裂,不完全性破裂,子宫破裂,原因,程度,部位,4,.,病因,1.,子宫手术史（瘢痕子宫）：较常见的原因,如剖宫产史、穿过或达到子宫内膜的肌瘤剔除史、子宫成形术。,机制：妊娠晚期或临产后,宫腔压力增大,肌纤维拉长、断裂,5,.,病因,2.,胎先露下降受阻,骨盆狭窄、头盆不称、软产道阻塞（如阴道横隔、宫颈瘢痕等）、胎位异常、胎儿异常（脑积水、连体儿）,机制：胎先露下降受阻,克服阻力，引起强烈宫缩,6,.,病因,3.,缩宫素使用不当,使用指征及剂量掌握不当,子宫对缩宫素过于敏感,4.,产科手术损伤,宫口未开全使用产钳术、胎儿吸引术造成宫颈撕裂,内转胎位术、植入胎盘强行剥离、机械损伤子宫,7,.,临床表现,子宫破裂是一个,渐进,的过程，可分为先兆子宫破裂和子宫破裂两个阶段。,先兆子宫破裂：,8,.,临床表现,病理性缩复环：子宫下段膨隆、压痛明显,（且随着产程进展凹陷逐渐上升达脐平甚至脐上）,产妇体征方面表现下腹剧痛难忍；排尿困难、血尿、烦躁不安，呼吸、心率加快,胎儿表现为：胎心率改变或听不清胎心,9,.,THANK YOU,SUCCESS,2024/12/16 周一,10,.,临床表现,完全性子宫破裂：,产妇突感撕裂样疼痛，呼吸急迫、面色苍白、脉搏细数血压下降等休克征象。,腹部查体：全腹有压痛、反跳痛，腹壁下清楚地扪及胎体，胎儿侧方可扪及缩小的宫体，胎动、胎心消失。,阴道检查：鲜血大量流出，宫口缩小，胎先露上升,破口位置较低，可扪及子宫前壁破口,11,.,临床表现,不完全性子宫破裂,多见于剖宫产子宫下段切口瘢痕裂开,症状和体征不明显，不完全破裂处有明显压痛。,不全破裂可累计子宫动脉，导致,急性大出血,，破裂发生在子宫侧壁阔韧带两叶间，可形成阔韧带内血肿。,12,.,鉴别诊断,重型胎盘早剥,宫腔内感染,胎膜早破、产程长、多次阴道检查。,出现腹痛和子宫压痛。,通常伴有：体温升高、白细胞及中性粒细胞、,C,反应蛋白升高。,多伴有外伤史、妊娠高血压疾病。,剧烈腹痛、阴道出血，子宫压痛。,超声提示：胎盘后血肿，胎儿在宫腔内。,13,.,护理,减轻疼痛，,监测生命体征，,防止子宫破裂,遵医嘱给予抑制宫缩药物，如哌替啶、吗啡,、硫酸镁,等。,做好剖腹产手术前的各项准备,给氧、,建立静脉通路,、配血,备血、,带药,等。,14,.,护理,抢救休克，维持正常的,生命体征,取,平卧位,、,快速输液、给药、输血。,吸氧，保暖。,密切观察病人血压、脉搏、呼吸、意识、阴道流血等情况，并记录,安抚产妇，做好心理护理,恐惧、惊慌,15,.,护理,防止子宫破裂,配合医生即刻剖宫产,帮助产妇减轻疼痛,Your text in here,配合医生抢救休克,做好产妇心理护理,16,.,预防及早期识别,重于一切！,17,.,2015-8-6,Thank You!,THANK YOU,SUCCESS,2024/12/16 周一,19,.,