直接扩散:泌尿系感染，细菌通过腹膜扩散至腹腔。
透壁性感染:肠内细菌通过肠壁进入腹腔，见于肝硬 化腹水、肾病、猩红热、营养不良等。
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解剖生理概要
➢ 腹膜：一层很薄的浆膜，分壁腹膜和脏腹膜。 腹膜几乎与全身皮肤面积相等，约1.7～2.0m2 。 腹膜是双向半透膜:水、电解质 、尿素及 小分子物
质可透过。 脏层腹膜固定于内平大脏卧腹，时腔形小，成腹因网腔此膜后腹、上膜肠部炎系及或膜膈手及下术韧位后带置病。低人 ➢ 腹膜腔：壁层取和半脏卧层位腹，膜可之避间免的大潜腹在腔腔的隙脓。液存于 腹膜腔是人体膈最下大区的或浆流膜入腔小。腹腔形成脓肿。
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病因
➢ 继发性腹膜炎(secondary peritonitis):腹内有原发性病 灶，如脏器炎症、穿孔、损伤破裂或手术污染所引起 的腹膜炎。
➢ 继发性腹膜炎病因:
腹内空腔器官穿孔 手术污染
腹腔脏器炎症扩散 开放性腹部损伤
腹前、后壁的严重感染
➢ 主要致病菌:
大肠杆菌最多见，其次厌氧拟杆菌、链球菌、变 形杆等。
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腹部疾病护理
唐山职业技术学院外科教研室 黄秋学
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
临床表现(Clinical
manifestation)
➢ 腹痛:最主要症状。
持续、剧烈腹痛
病灶部位最为显著
深呼吸、咳嗽及体位变换时加剧
➢ 恶心、呕吐: 早期腹膜刺激
脉搏增快＋体温下降
反射性（病胃情内凶容物险）
晚期麻痹性肠梗阻
溢出性(胆汁、粪水样）
➢ 体温、脉搏:早期正常 T升高、 P脉搏增快
小结—继发性腹膜炎病因
➢ 腹腔内炎症:急性阑尾炎、急性胆囊炎发生坏 疽、穿孔，女性生殖器官化脓性炎症，急性胰 腺炎，肝脓肿破裂等。
➢ 空腔脏器穿孔:胃十二指肠溃疡穿孔，肠管损 破裂，肠梗阻所致肠坏死穿孔。
➢ 腹部外伤或手术污染:腹部穿透伤，手术中污 染或消化道吻合口瘘。
➢ 实质性脏器破裂:肝脾破裂。
解剖生理概要
➢ 腹膜的动脉
来自肋间动脉和腹主动脉的分支。
➢ 静脉回腹流前壁腹膜炎时：可引起局部疼痛、压痛和 汇反入射门性静的脉腹及肌下紧腔张静。脉诊。断腹膜炎的主要依据。
➢ 神经支膈配肌: 中心部分的腹膜受到刺激时：通过膈神 壁层经腹的膜反:主射要可受引体起神肩经部(放肋射间性神痛经或和呃腰逆神。经的分支)
多为混合感染，毒性较强。
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病因
➢ 原发性腹膜炎(primary peritonitis):腹内无原发性病 灶，细菌经血行、泌尿道或女性生殖器进入腹腔，引 起腹腔感染。常见儿童、老人及肝硬化腹水者。
➢ 细菌进入腹腔途径:
血行播散:肺炎双球菌和链球菌从呼吸道或泌尿道的 感染灶，通过血行播散至腹腔。多见婴儿、儿童。
上行性感染:经女性生殖道进入，如淋菌性腹膜炎。
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解剖生理概要
➢腹膜具有渗出功能：
正常时：腹腔有75~100ml液体 ，起润滑作用。
急性炎症时：大量渗出，既可稀释毒素和减少刺激， 也可引起水电解质平衡失调和低蛋白血症。渗液中 的巨噬细胞能吞噬细菌、异物和破碎组织。
➢发生粘连:
炎性渗液中纤维蛋白沉积在病变周围形成粘连，可 防止感染扩散或修复受损组织，也可引起肠梗阻。
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➢ 感染中毒症状:高热、脉快、呼吸浅快、大汗、口干
面色苍白、发绀、脉微弱、血压下降、休克
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急性腹膜炎
Acute Peritonitis
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➢腹膜有很强吸收功能:
吸收渗液、血液、空气、毒素等。膈肌腹膜和上腹 部腹膜比盆腔腹膜吸收力强。
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的支配，对各种刺激敏感，痛觉定位准确。
脏层腹膜:受自主神经支配(来自交感N和迷走神经末 梢),对牵引、腔内压力、炎症、膨胀等刺激敏感, 钝 痛而定位差。受刺激心跳慢、BP下降 、肠麻痹。
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分类
细菌性
原发性
病因
发病机制
非细腹菌膜性炎的分类不是静 继发性
临床过程
止不变的，而是不断
地急变性化着。
局限性
亚急性
范围
弥漫性
慢性
外科临床约98%为急性继发性细菌性腹膜炎
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With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society