资源描述
,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,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,诊断学第二篇第五章胸部体检,诊断学第二篇第五章胸部体检,（优选）诊断学第二篇第五章胸部体检,2,（优选）诊断学第二篇第五章胸部体检2,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,3,概述chest physical examin,体检注意事项,环境(environment),暴露部位,体位(posture),顺序,对称(symmetry),chest physical examination,4,体检注意事项chest physical ex,胸部体表标志,(1),chest physical examination,5,胸部体表标志(1)chest physica,胸部体表标志,(2),chest physical examination,6,胸部体表标志(2)chest physical exam,胸部体表标志,(3),chest physical examination,7,胸部体表标志(3)chest physical exam,一、胸壁(chest wall),静脉正常时不明显,上下腔V受阻时充盈、曲张。,皮下气肿（subcutaneous emphysema）,捻发感（捻发音）,胸壁压痛,是胸痛常见病因之一。,注意胸骨叩压痛白血病,肋间隙回缩气道阻塞（三凹征之一）,膨隆胸水等,chest physical examination,8,一、胸壁(chest wall)chest,二、胸廓(thorax,chest),正常,成人:前后径 横径,1 1.5,小儿、老人,前后径略小于或=横径,chest physical examination,9,二、胸廓(thorax,chest)che,异常,扁平胸（flat chest）,肺TB,桶状胸（barrel chest）,COPD,chest physical examination,10,异常chest physical examin,机制气过水声,注意腋窝和锁骨上窝,皮下气肿（subcutaneous emphysema）,inspection of Lung&pleura,3、呼吸节律(rhythm),2、呼吸频率(frequency)、幅度(amplitude),特点,inspection of Lung&pleura,耳语音(whispered),chest physical examination,胸部体检内容(content),脊柱（vertebra）,chest physical examination,（R P=1 4）,chest physical examination,手法、对称、交叉对比,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,11,机制气过水声 异常chest physica,肋骨串珠,漏斗胸,12,肋骨串珠漏斗胸12,畸型胸,异常,chest physical examination,13,畸型胸异常chest physical examina,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,14,三、乳房(breast)chest ph,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,15,主要病变 chest physical ex,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,16,四、肺与胸膜(lung&pleura)c,异常 浅快呼吸肌麻痹,chest physical examination,4、语音共振（vocal resonance）,auscultation of lung&pleura,chest physical examination,chest physical examination,压迫性膨胀不全,异常肺泡呼吸音,percussion of Lung&pleura,一次多个、咳嗽后可消失、,三、乳房(breast),持续时间长，一次一个，,又称鸡胸（pigeon chest），,(大叶肺炎)(气胸),减弱或消失阻塞等,chest physical examination,暂停 5 sec 30 min,4、语音共振（vocal resonance）,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,17,异常 浅快呼吸肌麻痹 chest,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）,24次/min,下前侧部明显,resonance,呼气音延长哮喘等,清音,正常叩诊区与肺界(3),2、呼吸频率(frequency)、幅度(amplitude),resonance,异常 浅快呼吸肌麻痹,环境(environment),chest physical examination,体位(posture),湿罗音（moist rales）,双侧减弱肺气肿,(大叶肺炎)(气胸),4、语音共振（vocal resonance）,4、语音共振（vocal resonance）,桶状胸（barrel chest）,chest physical examination,(大叶肺炎)(气胸),传导途径中任一环节受阻,胸壁（chest wall）,breast examination,chest physical examination,呼吸过缓（bradypnea）,chest physical examination,清音,inspection of Lung&pleura,auscultation of lung&pleura,chest physical examination,、胸膜摩擦音,(pleural friction rub),意义同胸膜摩擦感,chest physical examination,auscultation of lung&pleura,42,2、呼吸频率(frequency)、幅度(amplitude,
展开阅读全文