健康评估第五章身体评估课件

As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.第五章身体评估 是评估者运用自己的感官或借助简单的工具（体温计、血压计、听诊器等），以了解机体健康状况的最基本的评估方法。第五章 身体评估 是评估者运用自己的感官或借助简1As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.第一节身体评估的基本方法一、评估前准备评估前准备1、知识准备；2、环境准备；3、器材准备；4、态度准备。第一节 身体评估的基本方法一、评估前准备2As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.二、基本方法（一）视诊视诊（二）触诊触诊 是通过手接触被评估者体表后得到的感觉来判断该部位状态的评估方法。可用于全身，特别是腹部评估。二、基本方法（一）视诊3As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.（二）触诊1、触诊方法触诊方法：分为浅部触诊法浅部触诊法和深部深部触诊法触诊法。（1）浅部触诊法浅部触诊法：将一手轻轻放在被评估处，利用掌指关节及腕关节的协同动作，以滑动或旋转的方式轻压触摸。（二）触诊1、触诊方法：分为浅部触诊法和深部触诊法。4As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.1、触诊方法（2）深部触诊法深部触诊法：可触及深度多超过2cm，使用于评估腹腔病变及脏器情况。1）深部滑行触诊法深部滑行触诊法：常用于腹腔深部包块和胃肠病变的评估。2）深压触诊法深压触诊法：用一到二个手指逐渐深压被评估部位。1、触诊方法（2）深部触诊法：可触及深度多超过2cm，使用于5As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.（二）深部触诊法3）双手触诊法双手触诊法：多用于肝、脾、肾和腹腔肿物的评估。4）冲击触诊法冲击触诊法：用3-4个并拢的指端，稍用力反复急促地向下冲击被检查局部，通过指端感触有无浮沉的肿块或脏器。2、注意事项、注意事项（二）深部触诊法3）双手触诊法：多用于肝、脾、肾和腹腔肿物的6As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.（三）叩诊 是用手指叩击、手掌拍击被查部位是用手指叩击、手掌拍击被查部位的表面，使之震动而产生音响，根据的表面，使之震动而产生音响，根据震动和音响的特点来判断被查部位的震动和音响的特点来判断被查部位的脏器状态的评估方法。主要用于脏器状态的评估方法。主要用于肺、肺、心脏及腹部心脏及腹部检查。检查。（三）叩诊 是用手指叩击、手掌拍击被查部位的表面7As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.1、叩诊方法（1）间接叩诊法间接叩诊法：评估者左手中指第二指节紧贴于叩诊部位，勿施重压，其余四指稍微抬起，勿与体表接触；右手指自然弯曲，以中指指端叩击左手中指第二指骨的前端。1、叩诊方法（1）间接叩诊法：评估者左手中指第二指节紧贴于叩8As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.叩诊方法（2）直接叩诊法直接叩诊法：主要用于评估胸部、腹部面积较广泛的病变，如大量胸水或腹水等。2、叩诊音叩诊音：即叩诊时被叩击部位产生的音响。根据音响的强弱、频率等差别可分为清音、浊音、实音、鼓音、清音、浊音、实音、鼓音、过清音过清音。叩诊方法（2）直接叩诊法：主要用于评估胸部、腹部面积较广泛的9As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.3、注意事项（1）环境应安静。（2）叩诊时被评估者应充分暴露被评估部位，肌肉放松。（3）注意左右对称部位叩诊音的对比。（4）叩击动作要灵活、短促、富有弹性。3、注意事项（1）环境应安静。10As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.（四）听诊 常用于肺、心血管、胃肠道肺、心血管、胃肠道等部位的评估。1、听诊方法听诊方法：（1）直接听诊法直接听诊法；（2）间接听诊法间接听诊法。（四）听诊 常用于肺、心血管、胃肠道等部位的评估11As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.2、注意事项（1）听诊环境要安静、温暖、避风。（2）听诊前应注意耳件的方向是否正确，官腔是否通畅；体件要紧贴于被评估的部位。（3）根据病情采取适当的体位；（4）听诊时注意力要集中。2、注意事项（1）听诊环境要安静、温暖、避风。12As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.（五）嗅诊 恶臭的脓液见于恶臭的脓液见于气性坏疽气性坏疽；痰液恶；痰液恶臭味提示臭味提示支气管扩张或肺脓肿支气管扩张或肺脓肿；呼气；呼气具有浓烈的酒味见于具有浓烈的酒味见于饮酒后饮酒后，出现刺，出现刺激性蒜味提示激性蒜味提示有机磷农药中毒有机磷农药中毒，肝臭，肝臭味见于味见于肝性脑病肝性脑病，烂苹果味见于，烂苹果味见于糖尿糖尿病酮症病酮症；尿液呈浓烈的氨味见于；尿液呈浓烈的氨味见于尿潴尿潴留及膀胱炎留及膀胱炎，呈鼠尿味多为，呈鼠尿味多为苯丙酮尿苯丙酮尿症症。（五）嗅诊 恶臭的脓液见于气性坏疽；痰液恶臭味提13As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.第二节一般状态评估一、生命体征：包括体温、脉搏、呼吸、血压。（一）体温体温（T）1、参考范围腋测法：腋测法：36-37；口测法：口测法：36.3-37.2；肛测法：肛测法：36.5-37.7。第二节 一般状态评估一、生命体征：包括体温、脉搏、呼吸、血压14As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.2、临床意义（1）发热发热：可分为低热、中度热、高热及超高热。其中非感染性发热非感染性发热可见于无菌性坏死物质的吸收、抗原-抗体反应、内分泌与代谢性疾病、体温调节中枢功能失常等。2、临床意义（1）发热：可分为低热、中度热、高热及超高热。其15As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.2、体温过低 主要见于休克、严重营养不良、主要见于休克、严重营养不良、甲状腺功能低下及过久暴露于低温甲状腺功能低下及过久暴露于低温环境中。环境中。2、体温过低 主要见于休克、严重营养不良、甲状腺16As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.（二）脉搏（P）1、脉率脉率：指每分钟脉搏的次数。正常成人脉率为成人脉率为60-100次次/分分，超过100次/分为脉率增快脉率增快，低于60次/分为脉率减慢脉率减慢。2、脉律脉律：指脉搏的节律，可反映心脏的节律。（二）脉搏（P）1、脉率：指每分钟脉搏的次数。17As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.3、动脉壁状态动脉壁状态；4、强弱强弱；5、波形波形：（1）交替脉交替脉：指节律规则而强弱交替出现的脉搏，是早期左心功能不全的重要体征。（2）水冲脉水冲脉：脉搏骤起骤落，急促有力。（3）奇脉奇脉：吸气时脉搏明显减弱或消失，又称吸停脉。3、动脉壁状态；18As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.（三）呼吸1、呼吸运动呼吸运动：包括胸式呼吸和腹式呼吸。2、呼吸频率与深度呼吸频率与深度：静息状态下，成人正常呼吸频率为12-20次次/分分，呼吸与脉搏之比为1:4。（三）呼吸1、呼吸运动：包括胸式呼吸和腹式呼吸。19As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.呼吸频率异常呼吸过缓呼吸过缓：呼吸频率低于12次/分；呼吸过速呼吸过速：呼吸频率高于20次/分。（2）呼吸深度异常呼吸深度异常：呼吸深快、库斯莫呼吸、浅快呼吸。呼吸频率异常呼吸过缓：呼吸频率低于12次/分；20As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.3、呼吸节律（1）叹气样呼吸叹气样呼吸；（2）潮式呼吸潮式呼吸；（3）间停呼吸间停呼吸。3、呼吸节律（1）叹气样呼吸；21As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.（四）血压 是血管内的血液对血管壁产生的侧压力，通常指动脉血压或体循环血压。收缩压收缩压：心室收缩时，主动脉内压力在收缩中期达到的最高值；舒张压舒张压：心室舒张时，主动脉压力在舒张末期所达到的最低值。收缩压与舒张压之差称脉压收缩压与舒张压之差称脉压。（四）血压 是血管内的血液对血管壁产生的侧压力，22As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.1、血压标准类别 收缩压(mmHg)舒张压(mmHg)正常血压 120 80正常高值 120-139 80-89高血压 1级高血压(轻度)140-159 90-99 2级高血压(中度)160-179 100-109 3级高血压(重度)180 110单纯收缩期高血压 140 901、血压标准类别 收缩压(mmHg)舒张压(m23As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.2、血压变化的临床意义（1）高血压；（2）低血压；（3）血压不对称；（4）上下肢血压差缩小；（5）脉压增大；（6）脉压减小。2、血压变化的临床意义（1）高血压；24As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.二、意识状态1、嗜睡；2、意识模糊；3、昏睡；4、谵妄；5、昏迷。二、意识状态1、嗜睡；25As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.三、面容表情1、急性病容急性病容：呼吸急促，面色潮红，唇有疱疹，表情痛苦；2、慢性病容慢性病容：面色晦暗，面容憔悴，目光黯淡，表情忧虑；3、肢端肥大症面容肢端肥大症面容：头颅增大，面部变长，下颌增大前凸，眉弓、两颧隆起，唇舌肥厚，耳鼻增大；三、面容表情1、急性病容：呼吸急促，面色潮红，唇有疱疹，表情26As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.面容表情4、二尖瓣面容二尖瓣面容：两颊紫红、面色晦暗、口唇轻度发绀；5、满月面容满月面容：面如满月，皮肤发红，常伴痤疮和胡须生长；6、甲状腺功能亢进面容甲状腺功能亢进面容：面容惊愕，眼球凸出，睑裂增宽，目光闪烁，表情兴奋；面容表情4、二尖瓣面容：两颊紫红、面色晦暗、口唇轻度发绀；27As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.面容表情7、粘液性水肿粘液性水肿：面色苍白，颜面水肿，目光呆滞，反应迟钝，眉毛及头发稀疏。8、苦笑面容苦笑面容：面肌痉挛，牙关紧闭，呈苦笑状。面容表情7、粘液性水肿：面色苍白，颜面水肿，目光呆滞，反应迟28As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.四、发育与体型（一）发育发育1、成人发育正常的评估指标成人发育正常的评估指标；2、发育异常发育异常。（二）体型体型1、无力型无力型；2、正力型正力型；3、超力型超力型。四、发育与 体型（一）发育29As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.五、营养状态标准体重男：体重（男：体重（kg）=身高（身高（cm）-80*0.7；女：体重（女：体重（kg）=身高（身高（cm）-70*0.6；体重指数体重指数BMI=体重（体重（kg）/身高（身高（m2）。）。1、营养不良：BMI18.5；2、营养过度。五、营养状态标准体重30As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.六、体位指被评估者所处的状态。（一）自主体位自主体位：身体活动自如，不受限制。（二）被动体位被动体位：自己不能变换或调整身体的位置。六、体位指被评估者所处的状态。31As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.（三）强迫体位为减轻痛苦而被迫采取的某种特殊体位。1、强迫卧位强迫卧位；2、强迫蹲位强迫蹲位；3、强迫坐位强迫坐位；4、辗转体位辗转体位；5、角弓反张位角弓反张位。（三）强迫体位为减轻痛苦而被迫采取的某种特殊体位。32As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.七、步态走动时所表现出的姿态。1、跨阈步态跨阈步态；2、慌张步态慌张步态；3、醉酒步态醉酒步态；4、蹒跚步态蹒跚步态；5、共济失调步态共济失调步态；6、剪刀步态剪刀步态。七、步态走动时所表现出的姿态。33As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.第三节皮肤、浅表淋巴结评估一、皮肤评估皮肤评估 包括颜色、湿度、弹性、皮疹、出血点、紫癜、水肿及瘢痕等。（一）颜色颜色1、苍白苍白：由于贫血、末梢毛细血管痉挛或充盈不足所致。第三节 皮肤、浅表淋巴结评估一、皮肤评估34As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.颜色2、发红发红：由于毛细血管扩张充血、血流加速、红细胞数量增多所致。3、发绀发绀：皮肤呈青紫色，常于口唇、耳廓、面颊及肢端等部位出现。颜色2、发红：由于毛细血管扩张充血、血流加速、红细胞数量增多35As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.4、黄染(1)黄疸黄疸 血清总胆红素超过34molL。(2)胡萝卜素增高胡萝卜素增高；(3)长期服用含有黄色素的药物长期服用含有黄色素的药物。5、色素沉着色素沉着 指部分或全身皮肤出现色泽加深的情况。6、色素脱失色素脱失 指皮肤失去原有的色素。4、黄染(1)黄疸 血清总胆红素超过34molL。36As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.(二)湿度(三三)弹性弹性 弹性良好者松手后皮肤皱褶迅速平复，弹性减弱者皱褶平复缓慢。(四四)皮疹皮疹1、斑疹斑疹 局部皮肤发红，一般不隆起也不凹陷。2、玫瑰疹玫瑰疹 鲜红色圆形斑疹，多出现于胸腹部。(二)湿度(三)弹性 弹性良好者松手后皮肤皱褶迅速平复，弹37As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.(四)皮疹3、丘疹丘疹 局部皮肤颜色改变，病灶凸出皮肤表面。4、斑丘疹斑丘疹 在丘疹周围有皮肤发红的地盘。5、荨麻疹荨麻疹 为稍隆起皮肤表面的苍白色或红色的局限性水肿。(四)皮疹3、丘疹 局部皮肤颜色改变，病灶凸出皮肤表面。38As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.(五)皮下出血根据直径大小及伴随情况分为以下几种。瘀点瘀点 出血直径出血直径小于小于2mm；瘀斑瘀斑 直径大于大于5mm；血肿血肿 片状出血并伴有皮肤显著隆起片状出血并伴有皮肤显著隆起。(五)皮下出血根据直径大小及伴随情况分为以下几种。39As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.(六)蜘蛛痣与肝掌 皮肤小动脉末端分支性扩张所形成的血管痣，称为蜘蛛痣蜘蛛痣。其形成与肝脏对雌激素的灭活作用减弱有关。肝掌肝掌 慢性肝病病人可见手掌鱼际、小鱼际发红，压之褪色。(六)蜘蛛痣与肝掌 皮肤小动脉末端分支性扩张所形40As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.(七)水肿 皮下组织的细胞内及组织间隙内液体过多积聚称为水肿水肿。轻度轻度；仅见于眼睑、眶下软组织、胫骨前、踝部皮下组织，指压后可见组织轻度下陷，平复较快；中度中度；全身组织均见明显水肿，指压后可出现明显凹陷，平复缓慢；重度重度；全身组织严重水肿，身体低垂部位皮肤发亮，甚至有液体渗出。(七)水肿 皮下组织的细胞内及组织间隙内液体过多41As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.二、浅表淋巴结评估(一)浅表淋巴结分布浅表淋巴结分布1、耳后、乳突；2、颌下淋巴结；3、颏下淋巴结；4、颈深部淋巴结；5、锁骨上淋巴结；6、腋窝淋巴结；7、腹股沟淋巴结。二、浅表淋巴结评估(一)浅表淋巴结分布42As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.(二)评估方法及顺序1、评估方法；2、评估顺序；3、注意事项。(二)评估方法及顺序1、评估方法；43As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.(三)淋巴结肿大的临床意义1、局限性淋巴结肿大局限性淋巴结肿大(1)非特异性淋巴结炎非特异性淋巴结炎；(2)淋巴结结核淋巴结结核；(3)恶性肿瘤淋巴结转移恶性肿瘤淋巴结转移。2、全身性淋巴结肿大全身性淋巴结肿大(三)淋巴结肿大的临床意义1、局限性淋巴结肿大44As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.第四节头部和颈部评估一、头部评估(一)头发和头皮；(二)头颅1、眼 评估顺序为由外向内。(1)眉毛；(2)眼睑第四节 头部和颈部评估一、头部评估45As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.眼睑1)上睑下垂；2)眼睑闭合障碍；3)眼睑水肿；4)睑内翻。眼睑1)上睑下垂；46As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.(3)结膜；(4)眼球；(5)角膜；(6)巩膜；(7)虹膜；(8)瞳孔。(3)结膜；47As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.2、耳1、外耳；2、中耳；3、乳突。2、耳1、外耳；48As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.3、鼻(1)鼻的外形；(2)鼻翼扇动；(3)鼻出血；(4)鼻腔粘膜；(5)鼻窦。3、鼻(1)鼻的外形；49As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.4、口腔(1)口唇；(2)口腔黏膜；(3)牙；(4)牙龈；(5)舌。4、口腔(1)口唇；50As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.5、咽部及扁桃体扁桃体增大分为三度扁桃体增大分为三度。不超过咽鄂弓者为不超过咽鄂弓者为I度，超过咽鄂弓者度，超过咽鄂弓者为为II度，达到或超过咽后壁中线者为度，达到或超过咽后壁中线者为III度度。5、咽部及扁桃体扁桃体增大分为三度。51As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.6、口腔的气味；7、腮腺。6、口腔的气味；52As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.二、颈部评估(一)颈部外形与分区；颈前三角；颈后三角。(二)颈部姿势与运动；(三)颈部皮肤与包块；(四)颈部血管。二、颈部评估(一)颈部外形与分区；53As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.(五)甲状腺甲状腺 位于甲状软骨下方和两侧，正常约15-25g，表面光滑，不易触及。1、视诊视诊 观察甲状腺的大小和对称性。2、触诊触诊 包括甲状腺峡部和甲状腺侧叶的检查。(五)甲状腺54As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.(1)甲状腺峡部甲状腺峡部；(2)甲状腺侧叶甲状腺侧叶1)前面触诊前面触诊；2)后面触诊后面触诊。3、听诊听诊(1)甲状腺峡部；55As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.3、听诊 甲状腺肿大甲状腺肿大可分三度；不能看出肿不能看出肿大但能触及者为大但能触及者为I度；能看到肿大又能度；能看到肿大又能触及，但在胸锁乳突肌以内者为触及，但在胸锁乳突肌以内者为II度；度；超过胸锁乳突肌外缘者为超过胸锁乳突肌外缘者为III度度。(六)气管气管3、听诊 甲状腺肿大可分三度；不能看出肿大但能触56As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.第五节胸部评估 指颈部以下和腹部以上的区域，由胸廓、胸肌、乳房、心脏、肺等构成。胸部评估的目的主要是判定心、肺、乳房等重要器官的生理、病理状态。第五节 胸部评估 指颈部以下和腹部以上的区域，由57As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.一、胸部的体表标志及分区 包括骨骼标志骨骼标志、自然陷窝自然陷窝与解剖解剖分区及体表标线分区及体表标线。(一)骨骼标志骨骼标志1、胸骨角胸骨角；其两侧分别与左右第2肋软骨相连，为计数肋骨和肋间隙的主为计数肋骨和肋间隙的主要标志要标志，相当于第4或第5胸椎水平。一、胸部的体表标志及分区 包括骨骼标志、自然陷窝58As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.骨骼标志2、肋间隙肋间隙；正常儿童及成年男子乳头约位于锁骨中线第4肋间隙。3、脊柱棘突脊柱棘突；后正中线的标志后正中线的标志。4、肩胛下角肩胛下角；相当于第相当于第8胸椎水平胸椎水平以及第7或第8肋骨水平，为后胸壁计数后胸壁计数肋骨的重要标志肋骨的重要标志。5、肋脊角肋脊角；为第12肋骨与脊柱构成的夹角。骨骼标志2、肋间隙；正常儿童及成年男子乳头约位于锁骨中线第459As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.(二)自然陷窝与解剖分区有4个自然陷窝和3个解剖区域；胸骨上窝、锁骨上窝、锁骨下窝、腋窝、肩胛上区、肩胛下区、肩胛间区。(三三)体表标线体表标线包括前正中线、锁骨中线、胸骨线、胸骨旁线、腋前线、腋中线、腋后线、肩胛线、后正中线。(二)自然陷窝与解剖分区有4个自然陷窝和3个解剖区域；60As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.二、胸壁、胸廓和乳房评估(一)胸壁胸壁1、静脉；2、皮下气肿；3、胸壁压痛；4、肋间隙。二、胸壁、胸廓和乳房评估(一)胸壁61As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.(二)胸廓1、扁平胸扁平胸；2、桶状胸桶状胸；3、佝偻病胸佝偻病胸(1)佝偻病串珠佝偻病串珠；(2)肋膈沟肋膈沟；(3)漏斗胸漏斗胸；(4)鸡胸鸡胸。(二)胸廓1、扁平胸；62As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.胸廓4、胸廓单侧变形胸廓单侧变形；5、胸廓局部隆起胸廓局部隆起；6、脊柱畸形引起的胸廓改变脊柱畸形引起的胸廓改变。胸廓4、胸廓单侧变形；63As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.(三)乳房1、视诊视诊(1)对称性及大小；(2)皮肤情况；橘皮样病变橘皮样病变；(3)腋窝和锁骨上窝。(三)乳房1、视诊64As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.(三)乳房2、触诊触诊(1)硬度和弹性；(2)压痛；(3)包块。(三)乳房2、触诊65As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.三、肺和胸膜评估(一)视诊视诊(二)触诊触诊1、胸廓扩张度胸廓扩张度(1)评估方法；(2)临床意义；1)双侧胸廓扩张度增强双侧胸廓扩张度增强；2)双侧胸廓扩张度降低双侧胸廓扩张度降低；3)一侧胸廓扩张受限一侧胸廓扩张受限。三、肺和胸膜评估(一)视诊66As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.2、语音震颤语音震颤(1)评估方法；(2)临床意义；1)生理改变生理改变；成人较儿童强，男性较女性强，消瘦者比肥胖者强；前胸上部较前胸下部强，右胸上部较左胸上部强；2)病理改变病理改变；3、胸膜摩擦感胸膜摩擦感。2、语音震颤67As the only big agricultural village in Tianding Township,some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year.(三)叩诊1、叩诊的方法叩诊的方法；2、叩诊音的分类、影响因素叩诊音的分类、影响因素；3、正常胸部