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14:45:03</time></span> <span id="q9nwfgo" class="sp1 c6 fl"><em id="zuozhe" class="noshow">鞏詩</em><em class="user_id noshow">754</em>由 <em class="nickname"></em> 分享</span> <span id="stlw4f0" class="fl arc_btn"></span> </div> </div> </div> <div id="lhjezcf" class="y_ju"></div> <div id="dslnztf" class="con_article con_main" id="contentText"> <p>吃完飯想吐是因?yàn)槭裁?/p><p> 嘔吐是胃內(nèi)容物反入食管，經(jīng)口吐出的一種反射動作?？煞譃槿齻€(gè)階段，即惡心、干嘔和嘔吐，但有些嘔吐可無惡心或干嘔的先兆。嘔吐可將咽入胃內(nèi)的有害物質(zhì)吐出，是機(jī)體的一種防御反射，有一定的保護(hù)作用，但大多數(shù)并非由此引起，且頻繁而劇烈地嘔吐可引起脫水、電解質(zhì)紊亂等并發(fā)癥。</p><p><strong>嘔吐的分類</strong></p><p> 一般分反射性,中樞性,前庭障礙性,神經(jīng)官能性四大類。</p><p> 反射性嘔吐</p><p> 消化系統(tǒng)：咽部刺激(如人為的刺激)、急性胃腸炎、慢性胃炎、消化性潰瘍活動期、急性胃腸穿孔、幽門梗阻、大量出血、胃粘膜脫垂、急性胃擴(kuò)張、胃扭轉(zhuǎn)、急性腸炎、急性闌尾炎、機(jī)械性腸梗阻、急性出血壞死件腸炎、急性肝炎、慢性活動性肝炎、肝硬化晚期、急性慢性膽囊炎、膽石癥、膽道蛔蟲病、急性胰腺炎、急性腹膜炎等。其他系統(tǒng)：泌尿生殖系疾?。狠斈蚬芙Y(jié)石、急性腎孟腎炎、急性盆腔炎、異位妊娠破裂等;心血管疾?。盒募」Ｋ?、充血性心力衰竭等;眼耳疾病及其他：青光眼、屈光不正等。</p><p> 中樞性嘔吐</p><p> 神經(jīng)系統(tǒng)：偏頭痛、腦膜炎、腦出血、腦栓塞、高血壓腦病、腦腫瘤、腦震蕩、顱內(nèi)血腫、癲癇持續(xù)狀態(tài)等;感染性疾病：急性病毒、支原體、立克次體、細(xì)菌、螺旋體或寄生蟲感染;內(nèi)分泌與代謝紊亂：婦女早期妊娠、尿毒癥、肝性昏迷、低血糖癥、糖尿病酮癥、代謝性酸堿失衡、甲亢危象、腎上腺皮質(zhì)功能減退、營養(yǎng)不良、維生素缺乏癥。其他：休克、缺氧、急性溶血、中暑、高熱等;許多藥物有惡心嘔吐的副作用：阿樸嗎啡、雌激素與避孕藥、乙酸水楊酸制劑、鏈霉素、卡那霉素、新霉素、慶大霉素、氯霉素、紅霉素、異煙阱、降糖靈、保泰松、苯妥因鈉、各種抗癌藥物等;中毒：酒精、硫酸銅、鉛、砷、砒、苯、苯胺、一氧化碳、有機(jī)磷等中毒;最后，還有神經(jīng)性嘔吐。</p><p> 前庭障礙性</p><p> 迷路炎，美尼爾病，暈動病</p><p> 神經(jīng)官能性</p><p> 胃神經(jīng)官能證，癔病</p><p> 對嘔吐的初步綜合判斷</p><p> 如果您或家人、同事、朋友發(fā)生了惡心嘔吐，倘若您能根據(jù)發(fā)病情況初步判斷一下其原因和歸類，就能做到去醫(yī)院時(shí)掛什么科的號心中有數(shù)，并在向醫(yī)生敘述病情時(shí)詳細(xì)周到而又準(zhǔn)確。</p><p><strong>了解病史</strong></p><p> 餐后近期內(nèi)出現(xiàn)嘔吐，并有驟起的集體發(fā)病情況，先應(yīng)考慮食物中毒。活動期消化性潰瘍位于幽門，因該處水腫、充血、痙攣，也常導(dǎo)致餐后嘔吐;神經(jīng)性嘔吐多在餐后即刻發(fā)生。在餐后較久或積數(shù)餐之后才出現(xiàn)嘔吐的，多見于消化性潰瘍、胃癌等引起的幽門、十二指腸慢性不全梗阻。</p><p> 嘔吐發(fā)生時(shí)間晨間嘔吐在育齡女性應(yīng)考慮早孕反應(yīng)，有時(shí)也見于尿毒癥或慢性酒精中毒。有些鼻竇炎因分泌物刺激咽部，也有晨起惡心和干嘔。夜間嘔吐多見于幽門梗阻。</p><p> 嘔吐的特點(diǎn) 一般嘔吐常先有明顯惡心，然后出現(xiàn)嘔吐。但神經(jīng)性嘔吐可不伴有惡心或僅有輕微惡心，嘔吐并不費(fèi)力，甚至可以隨心所欲地嘔吐。高血壓腦病或顱內(nèi)病變引起顱內(nèi)壓增高時(shí)，也常常沒有惡心而突然出現(xiàn)噴射狀嘔吐。</p><p> 嘔吐物的性質(zhì) 幽門梗阻的嘔吐物含有隔餐或隔日食物，有腐酵酸臭氣味。嘔吐物中含有多量黃色苦味膽汁，多見于頻繁劇烈嘔吐或十二指腸乳頭以下的腸梗阻。大量嘔吐多見于幽門梗阻或急性胃擴(kuò)張，一次嘔吐可超過1000ml。嘔吐物有大便臭味的可能是低位腸梗阻。嘔吐大量酸性胃液多見于高酸性胃炎、活動期十二指腸潰瘍或胃泌素瘤。嘔吐物呈咖啡樣或鮮紅色，考慮上消化道出血，請參看嘔血與黑便。</p><p> 嘔吐伴有腹痛伴有腹痛者，首先應(yīng)考慮急腹癥，要及時(shí)就診。請參看腹痛。慢性腹痛可在嘔吐之后獲得暫時(shí)緩解，可能是消化性潰瘍、急性胃炎或高位腸梗阻;但在膽囊炎、膽石癥、膽道蛔蟲病、急性胰臟炎等，則嘔吐一般不能使腹痛得到緩解。</p><p> 嘔吐伴頭痛與眩暈伴有頭痛，應(yīng)考慮高血壓腦病、偏頭痛、鼻竇炎、青光眼、屈光不正等。伴有眩暈者可能是梅尼埃病、迷路炎等，還需要了解是否由硫酸鏈霉素、卡那霉素、新霉素或慶大霉索等藥物引起。</p><p> 另外對惡心嘔吐伴有厭食、疲乏，甚至出現(xiàn)黃疸，應(yīng)該警惕是否為病毒性肝炎，及時(shí)就診并隔離。在育齡女性必須了解月經(jīng)情況，如果未經(jīng)避孕(或避孕失敗)而超過4周尚未行經(jīng)者，要考慮是否為早孕所致的惡心與嘔吐。我在臨床上曾遇到一位36歲的婦女，因惡心嘔吐兩月，四處看醫(yī)生，天天服中西藥，就是無效。后來了解到她月經(jīng)已三月未行，因?yàn)?ldquo;上環(huán)”了，因此之前的醫(yī)生沒有考慮妊娠、我囑其做子宮B超，結(jié)果發(fā)現(xiàn)，懷孕兩個(gè)多月了。自愿人工流產(chǎn)后，惡心嘔吐的癥狀完全消失。還有一位40歲婦女，反復(fù)嘔吐4個(gè)月，四處投醫(yī)，遍服中蒙西藥，無效，延醫(yī)與我，體檢時(shí)發(fā)現(xiàn)貧血征，即囑其做腎功能全項(xiàng)，結(jié)果，BUN、SCR數(shù)倍于正常，原來，她的嘔吐是由于腎病綜合癥導(dǎo)致的電介質(zhì)紊亂和酸堿失衡引起。</p><p> 與嘔吐在臨床上十分常見。多因消化系統(tǒng)本身病變所致，也可因消化系統(tǒng)以外的全身性疾病導(dǎo)致。要想對惡心與嘔吐作出正確診斷，需要去醫(yī)院進(jìn)行全面系統(tǒng)的檢查。反復(fù)和持續(xù)的劇烈嘔吐多引起嚴(yán)重并發(fā)癥，故應(yīng)該予以重視，及時(shí)到醫(yī)院檢查治療。</p><p><strong>嘔吐的發(fā)生機(jī)制：</strong></p><p> 主要是食管和胃的擴(kuò)張，以及膈肌和腹肌的強(qiáng)烈收縮，使得胃的食糜被吐出來，過強(qiáng)烈的嘔吐也可以把部分小腸的食糜也吐出來。嘔吐能夠把有毒的物質(zhì)或者異物排除體外，對于人體是有益的，但是過度的嘔吐容易造成機(jī)體電解質(zhì)平衡紊亂，如代謝性堿中毒，注意補(bǔ)充一些酸性物質(zhì)，尤其是小兒和老年人。</p> </div> <div id="vilodxz" class="y_ju"></div> <div id="datoysc" class="pnum"> <ul id="page_slice"> <div id="fuwq90f" 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