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1、依普比善在胃肠外科的 临床应用解放军总医院普外胃肠病区唐 云 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.关于依普比善 通用名：醋酸奥曲肽注射液 商品名：依普比善 英文名：Octreo
2、tide Acetate Injection 人工合成的八肽化合物，为十四肽人生长 抑素类似物，具有与天然内源性生长抑素 类似的作用，但作用较强且持久，半衰期 较天然抑素长30倍Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2
3、011 Aspose Pty Ltd.人生长抑素 生长抑素广泛存在于胃肠道粘膜的“D”细胞 ，以胃窦和胃体最高，在肠内越往下含量 越低 在胰腺内，生长抑素由胰岛“D”细胞分泌Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-201
4、1 Aspose Pty Ltd.生长抑素的生理作用 抑制垂体生长激素、促甲状腺激素、促肾 上腺皮质激素和催乳类的释放 抑制各种胃肠激素的释放，抑制胃泌素、 促胰液素、胆囊收缩素、胃动素、胰高血 糖素、肠高血糖素等的释放 抑制胃酸、胃蛋白酶、胰蛋白酶及唾液淀 粉酶的分泌Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyr
5、ight 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.醋酸奥曲肽的药理作用 抑制胃、肠、胰腺的外分泌 抑制胃、肠、胰腺的内分泌 减少胃肠蠕动，减少胆囊排空 降低内脏血流量和门脉压力Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 20
6、04-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.胃肠外科的临床应用 肠梗阻 胃肠瘘 胃肠手术后出血Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 As
7、pose Pty Ltd.肠梗阻最重要的鉴别诊断 单纯性肠梗阻 绞窄性肠梗阻王淼, 褚海平.奥曲肽延误绞窄性肠梗阻手术2 例分析.中 国误诊学杂志，2009，9 （22 ）：5425-5426Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright
8、 2004-2011 Aspose Pty Ltd.绞窄性肠梗阻绞窄性肠梗阻可发生于单纯性 机械性肠梗阻的基础上， 单纯性肠梗阻因治疗不善而转 变为绞窄性肠梗阻的占15 43%。Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2
9、011 Aspose Pty Ltd.出现下列征象应疑有绞窄性肠梗阻： 1.急骤发生的剧烈腹痛持续不减，或由阵发性绞痛转变为 持续性腹痛，疼痛的部位较为固定。若腹痛涉及背部提示 肠系膜受到牵拉，更提示为绞窄性肠梗阻 2. 呕吐物、胃肠减压引流物、腹腔穿刺液含血液，亦可 有便血。 3.X线平片检查可见梗阻部位以上肠段扩张并克满液体， 状若肿瘤或呈“C”形面被称为“咖啡豆征”，在扩张的 肠管间常可见有腹水 4.腹部有压痛，反跳痛和腹肌强直，腹胀与肠鸣音亢进则 不明显 5.全身情况急剧恶化，毒血症表现明显，可出现休克。 。 Evaluation only.Evaluation only. Creat
10、ed with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.依普比善在肠梗阻的临床应用 术后早期炎性肠梗阻 粘连性肠梗阻 老年胃肠手术后肠梗阻 晚期癌性肠梗阻 假性肠梗阻 非绞窄性肠梗阻Evaluation only.Evaluation only. Created with
11、 Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 动力性肠梗阻（假性肠梗阻）包括常见的 麻痹性和少见的痉挛性肠梗阻 机械性肠梗阻肠梗阻另一比较重要的鉴别 动力性肠梗阻开刀是医疗错误 绞窄性肠梗阻不开刀更是医疗错误Evaluation only.Evaluation only.
12、Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.依普比善在肠梗阻应用的小结 依普比善不能完全阻止绞窄性肠梗阻的出 现 依普比善使由单纯性肠梗阻转变为绞窄性 肠梗阻的发生率降低 依普比善的使绞窄性肠梗阻的症状变的不 典型 依普比善可治愈一些非绞窄性肠梗阻E
13、valuation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.依普比善在胃肠瘘的应用Evaluation only.Evaluation only. Created with Aspose.Slides
14、for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.胃癌 胃癌切除术后出现胃肠道瘘是手术后最严重的并发症 胃癌切除术后出现胃肠道瘘为15% 胃癌切除术后出现胃肠道瘘的死亡率为2540%Evaluation only.Evaluation only. Created with Aspose.Slides for
15、.NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.胰胰 岛岛 素素依依 普普 比比 善善洛洛 赛赛 克克冲冲 洗洗 液液控控 制制 速速 度度抗抗 感感 染染雾雾 化化 吸吸 入入从1997年1月至2008年6月，开展了综合技 术治疗胃癌手术后消化道瘘并发症的临床研 究Evaluation only.Evaluati
16、on only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.胃癌术后胃肠道瘘的治疗 改进五项关键技术1.腹腔双套管24小时持续冲洗主动引流技术2.消化道腔内引流技术3.创建肠内营养支持途径技术A 直接穿刺建立肠内营养支持途径技术B 切开腹壁建立肠内营养支持途径技术C 胃镜下建立鼻肠管肠内营养支持途径技术D X线下建立鼻肠管肠内营养支持途径技术4.肠外营养支持平稳过渡到肠内营养支持技术5.系统集成药理营养素作用技术Evaluation only.Evaluation only. Created
