诊断学第二篇第五章胸部体检.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,第二篇第五章,胸 部 体 检,1,概述,胸部体检内容(content),胸骨,（,sternum）,胸廓,（chest）,肋骨,（rib）,脊柱,（vertebra）,胸壁,（chest wall）,乳房,（breast）,肺与胸膜,（lung and pleura）,心脏,chest physical examination,2,体检注意事项：,环境,(environment),暴露部位,体位,(posture),顺序,对称,(symmetry),chest physical examination,3,胸部体表标志,(1),chest physical examination,4,胸部体表标志,(2),chest physical examination,5,胸部体表标志,(3),chest physical examination,6,异常,扁平胸（flat chest）,肺TB,桶状胸（barrel chest）,COPD,chest physical examination,9,异常,佝偻病胸（rachitic chest）：,又称鸡胸（pigeon chest），,佝偻病串珠,（rachitic rosary）,肋膈沟,（Harrisons groove）,漏斗胸,（funnel chest）,chest physical examination,10,肋骨串珠,漏斗胸,11,畸型胸,异常,chest physical examination,12,三、乳房(breast),主要方法：,视诊,对称、表观、乳头、,皮肤回缩、,注意腋窝和锁骨上窝,触诊,硬度弹性、压痛、包块,chest physical examination,13,主要病变,炎症,红、肿、热、痛、,硬结包块,肿瘤,恶性：粘连包块、桔皮样,良性：活动、界清的包块,chest physical examination,breast examination,14,四、肺与胸膜(lung&pleura),（一）inspection,1呼吸运动,正常：男性、儿童,腹式呼吸为主,女性 ,胸式呼吸为主,异常：,正常呼吸运动发生改变,chest physical examination,15,2、呼吸频率,(frequency),、幅度,(amplitude),正常,成人：16-20次/min;,（R：P=1：4）,新生儿：44次/min,chest physical examination,inspection of Lung&pleura,16,2、呼吸频率,(frequency),、幅度,(amplitude),异常,呼吸过速（tachypnea）,24次/min,(发热),呼吸过缓（bradypnea）,12次/min,(麻醉过量),chest physical examination,inspection of Lung&pleura,17,2、呼吸频率,(frequency),、幅度,(amplitude),异常,浅快：呼吸肌麻痹,深快：剧烈运动,深慢：Kussmauls 呼吸,chest physical examination,inspection of Lung&pleura,18,3、,呼吸节律(rhythm)：,正常 均匀,异常,潮式呼吸（Cheyne-Stokes）：,周期 30 sec 2 min,暂停 5 sec 30 min,chest physical examination,inspection of Lung&pleura,19,3、,呼吸节律(rhythm)：,正常 均匀,异常 间停呼吸（Biots呼吸）：,中枢病变，比上更重。,抑制性呼吸：,疼痛时,叹息样呼吸（sighing）：,神经衰弱等,chest physical examination,inspection of Lung&pleura,20,（二）,palpation:,1胸廓扩张度,（thoracic expansion）,手法,深呼吸,对比,单侧减弱：,胸水、肺不张等,。,双侧减弱：,肺气肿,chest physical examination,21,2、,语音(触觉）震颤,vocal（tactile)fremitus,发音 传导 手感,手法、对称、交叉对比,正常传导环节对音感影响,发音、密度、邻近器官,胸壁,chest physical examination,palpation of Lung&pleura,22,增强：,空洞、实变、,压迫性膨胀不全,减弱：,传导途径中任一环节受阻,chest physical examination,palpation of Lung&pleura,23,3胸膜摩擦感,（,pleural friction fremitus,）,双相,下前侧部明显,皮革摩擦的感觉：,急性胸膜炎,chest physical examination,palpation of Lung&pleura,24,（三）percussion:,方法：,直接,（immediate）,间接,（mediate）,基本音,清、鼓、浊、实,正常叩诊区与肺界,chest physical examination,25,正常叩诊区与肺界(1),chest physical examination,percussion of Lung&pleura,26,正常叩诊区与肺界(2),chest physical examination,percussion of Lung&pleura,27,正常叩诊区与肺界(3),percussion of Lung&pleura,chest physical examination,28,正常叩诊区与肺界(4),chest physical examination,percussion of Lung&pleura,29,异常叩诊音：,实音(,flatness,)过清音(,hyperresonance,),(,胸水,)(,肺气肿,),清音,resonance,浊音(,dullness,)鼓音(,tympany,),(,大叶肺炎,)(,气胸,),浊鼓音,(,肺水肿,),chest physical examination,percussion of Lung&pleura,30,（四）Auscultation,1、,正常呼吸音,chest physical examination,31,2、异常呼吸音：,异常肺泡呼吸音,减弱或消失：,阻塞等,增强：,缺氧、酸中毒等,呼气音延长：,哮喘等,断续：,局部炎症,粗糙：,炎症,chest physical examination,auscultation of lung&pleura,32,异常支气管呼吸音,正常肺泡呼吸音的部位,听到支气管呼吸音：,实变、空腔、,膨胀不全,chest physical examination,auscultation of lung&pleura,33,异常支气管肺泡呼吸音,正常肺泡呼吸音部位,听到混合呼吸音：,病因与上类似，,但掺杂正常组织,chest physical examination,auscultation of lung&pleura,34,3、罗音（rales）,干罗音（rhonchi）,机制：狭窄、部分阻塞：,炎症、痉挛、,肿瘤、异物,auscultation of lung&pleura,chest physical examination,35,特点：,持续时间长，一次一个，,呼气相更显，易变，,双侧多见。,分类：,鼾音（sonorus）：,低调,哨笛音（sibilant）：,高调,局限：,内膜TB、肿瘤,广泛：,哮喘,auscultation of lung&pleura,chest physical examination,36,湿罗音（moist rales）,水泡音（,bubble sound,）,机制：,气过水声,特点：,断续而短暂、,一次多个、咳嗽后可消失、,多在吸气相(末)、,恒定。,chest physical examination,auscultation of lung&pleura,37,分类：,大,中,小,捻发音,chest physical examination,auscultation of lung&pleura,38,意义：,炎症、肺水肿等,auscultation of lung&pleura,chest physical examination,捻发音发生机制,39,4、语音共振（vocal resonance）,机理与意义：,语音震颤,异常支气管呼吸音 同时出现,语音共振,支气管语音,（bronchophony）,胸语音,(pectoriloquy),羊鸣音,(egophony),耳语音,(whispered),性质变化时：,chest physical examination,auscultation of lung&pleura,40,、胸膜摩擦音,(pleural friction rub),意义同胸膜摩擦感,chest physical examination,auscultation of lung&pleura,41,小结,讨论：一侧 胸腔积液,的肺部体检,（,阳性与阴性体征,）,chest physical examination,42,谢谢,43,