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【PPT】恶心与呕吐

  • 2026-06-26 13:46:35
【PPT】恶心与呕吐

【考点笔记】

【考点笔记】恶心与呕吐

注：如需考点笔记版PDF（方便打印/做笔记），发送关键词“恶心与呕吐”。

【考点大纲】

一、概述与定义辨析 ★★★☆☆

编号
考点内容
重要程度
得分要点提醒
1.1
恶心、干呕、呕吐、反食的定义与区别
★★★☆☆
反食无恶心干呕，呕吐有明确前驱动作
1.2
迷走神经兴奋在恶心中的表现
★★☆☆☆
皮肤苍白、出汗、流涎、血压↓、心动过缓

二、发病机制：呕吐反射的神经回路 ★★★★★

编号
考点内容
重要程度
得分要点提醒
2.1
呕吐中枢：位置（延髓外侧网状结构背部）、功能（执行）
★★★★★
运动输出总司令部
2.2
化学感受器触发带（CTZ） ：位置（延髓第四脑室底面最后区）、特征（血脑屏障不完整）、功能（化学侦察）
★★★★★
CTZ感受化学毒物，是药物/代谢性呕吐的核心
2.3
呕吐中枢的四种传入冲动来源：消化道/心脏（迷走）、前庭系统、CTZ、大脑皮层/边缘系统
★★★★☆
对应三大类病因分类
2.4
呕吐反射全过程：恶心→干呕→呕吐的肌肉动力学（腹压驱动、声门关闭、贲门开放）
★★★☆☆
强调腹压是主要动力，声门关闭防止误吸

三、病因学：三大分类及代表疾病 ★★★★★

（一）反射性呕吐 ★★★★★

考点
重要程度
核心机制与特征
迷走/交感传入→呕吐中枢
★★★★☆
常见于内脏受刺激
幽门梗阻：呕吐宿食、发酵味、吐后缓解
★★★★★
必考！典型临床表现
低位小肠梗阻：粪臭味呕吐物
★★★★★
急腹症信号
急性心肌梗死（下壁）表现为上腹痛+呕吐
★★★★★
最易误诊的高危考点
高位/低位肠梗阻的呕吐特点对比
★★★★☆
高位：早、频、胆汁；低位：晚、粪臭
肝胆胰疾病：右上腹痛+发热+黄疸
★★★☆☆
Charcot三联征

（二）中枢性呕吐 ★★★★★

考点
重要程度
核心机制与特征
CTZ或呕吐中枢直接受刺激
★★★★☆
无需外周信号
颅内高压三联征：喷射性呕吐+剧烈头痛+意识障碍
★★★★★
喷射性=前驱恶心少、吐后头痛不缓解
糖尿病酮症酸中毒、尿毒症：内源性毒素→CTZ
★★★★☆
代谢病常见呕吐原因
化疗药物：顺铂等→5-HT₃→极强致吐
★★★☆☆
肿瘤支持治疗重点
神经性呕吐：恶心轻、进食即呕、营养好
★★★☆☆
精神因素，青年女性多见

（三）前庭障碍性呕吐 ★★★★☆

考点
重要程度
核心机制与特征
前庭神经→呕吐中枢
★★★☆☆
必须有眩晕、眼球震颤
梅尼埃病三联征：旋转性眩晕+听力下降+耳鸣
★★★★☆
膜迷路积水
晕动病：视觉与前庭感觉冲突，无听力障碍
★★★☆☆
乘车/船诱发
迷路炎：化脓性中耳炎史+眩晕
★★☆☆☆
感染来源是关键

四、临床表现与问诊核心“五维” ★★★★★

维度
考点（关键特征→推断疾病）
重要程度
时间
晨吐→早孕/鼻窦炎；夜间→幽门梗阻
★★★★☆
与进食关系
餐即吐→精神性/幽门管溃疡；餐后>1h→胃轻瘫；宿食→幽门梗阻
★★★★★
呕吐物性质无胆汁（乳头上）vs 多胆汁（乳头下）；粪臭味（低位梗阻）；咖啡色（上消化道出血）
★★★★★
特点喷射性→颅高压
★★★★★
伴随症状
+头痛+意识障碍=颅高压；+右上腹痛+发热=胆道感染；+胸痛=心梗；+眩晕+耳鸣=梅尼埃病
★★★★★

五、诊断与治疗 ★★★★☆

考点
重要程度
核心要点
诊断流程：先排险（颅高压、心梗、急腹症），再按五维问诊+检查
★★★☆☆
止吐药不能随意掩盖病情
止吐药物靶点：D₂受体（甲氧氯普胺）、5-HT₃受体（昂丹司琼）、H₁受体（苯海拉明）+M受体（东莨菪碱）用于晕动病、NK1受体（阿瑞匹坦）
★★★★★
药理高频考点
化疗呕吐三联方案：5-HT₃拮抗剂+NK1拮抗剂+地塞米松
★★★☆☆
肿瘤学考点
呕吐导致的酸碱失衡：低钾低氯性代谢性碱中毒，补等渗盐水+KCl
★★★★★
必考，注意“见尿补钾”

六、预后 ★★★☆☆

  • 良性自限性：急性胃肠炎、晕动病
  • 争分夺秒类：肠梗阻、心梗、颅高压
  • 长期管理类：化疗、尿毒症、胃轻瘫
  • 多学科协作类：神经性呕吐

【PPT-预览】-93页

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  1. CONNECT:[ UseTime:0.000580s ] mysql:host=127.0.0.1;port=3306;dbname=h_sjds;charset=utf8mb4
  2. SHOW FULL COLUMNS FROM `fenlei` [ RunTime:0.000747s ]
  3. SELECT * FROM `fenlei` WHERE `fid` = 0 [ RunTime:0.000356s ]
  4. SELECT * FROM `fenlei` WHERE `fid` = 63 [ RunTime:0.000280s ]
  5. SHOW FULL COLUMNS FROM `set` [ RunTime:0.000481s ]
  6. SELECT * FROM `set` [ RunTime:0.000215s ]
  7. SHOW FULL COLUMNS FROM `article` [ RunTime:0.000638s ]
  8. SELECT * FROM `article` WHERE `id` = 527943 LIMIT 1 [ RunTime:0.000450s ]
  9. UPDATE `article` SET `lasttime` = 1783322557 WHERE `id` = 527943 [ RunTime:0.013440s ]
  10. SELECT * FROM `fenlei` WHERE `id` = 64 LIMIT 1 [ RunTime:0.000428s ]
  11. SELECT * FROM `article` WHERE `id` < 527943 ORDER BY `id` DESC LIMIT 1 [ RunTime:0.000522s ]
  12. SELECT * FROM `article` WHERE `id` > 527943 ORDER BY `id` ASC LIMIT 1 [ RunTime:0.000584s ]
  13. SELECT * FROM `article` WHERE `id` < 527943 ORDER BY `id` DESC LIMIT 10 [ RunTime:0.000641s ]
  14. SELECT * FROM `article` WHERE `id` < 527943 ORDER BY `id` DESC LIMIT 10,10 [ RunTime:0.000606s ]
  15. SELECT * FROM `article` WHERE `id` < 527943 ORDER BY `id` DESC LIMIT 20,10 [ RunTime:0.000671s ]
0.090908s