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郑州大学第一附属医院CardiacBasicExamination心脏基本检查inspection视诊palpation触诊percussion叩诊auscultation听诊郑州大学第一附属医院InspectionoftheHeart心脏视诊precordiumshape心前区外形normalapicalimpulse正常心尖搏动abnormalapicalimpulse异常心尖搏动precordialabnormalimpulse心前区异常搏动郑州大学第一附属医院PrecordiumShape心前区外形Precordialbulge心前区隆起Features:bonybulge特点:骨骼突起Clinicalimportance:Congenitalheartdiseasewithventricularenlargement提示:先天性心脏病右室大Precordialsatiety心前区饱满Features:intercostalregionstickingout特点:肋间软组织外突Clinicalimportance:massofpericardialeffusion提示:大量心包积液郑州大学第一附属医院NormalApicalImpulse正常心尖搏动Location:0.5~1cmtotheleftmidclavicularlineatthe5thICSoutsideLSB.Range:2~2.5cmDirection:outwardwhenventricularsystolebegins位置第5肋间左锁骨中线内0.5~1cm范围2~2.5cm方向收缩时向外搏动意义提示心尖位置代表收缩期提示心脏大小郑州大学第一附属医院AbnormalLocationofApicalImpulse心尖搏动位置改变Physical:posture,pregnancy,etc.生理因素:体位妊娠Heartdiseases心脏病变L.VandB.Venlargement:inferiorleft左室或双室扩大:左下移位R.Venlargement:left右室扩大:向左移位Chestandabdominaldiseases肺部或腹部疾病郑州大学第一附属医院AbnormalApicalImpulse异常心尖搏动Abnormalrangeorintensity范围强度异常Increasedintensity:LVhypertrophy,hyperthyroidism,fever,anemia,etc.搏动增强:左室肥厚甲亢发热贫血Decreased:myocardialdiseases,pericardialeffusion,pleuraleffusionofleftthoraxorleft-sidepneumothorax,emphysema.搏动减弱:心肌病变心包积液肺气肿左胸腔积液或气胸Abnormaldirection方向改变Inwardimpulse:adhesivepericarditis.负性心尖搏动:心包粘连郑州大学第一附属医院PrecordialAbnormalImpulse心前区异常搏动2ndICS,LSB:pulmonaryhypertension,youth胸骨左缘第二肋间:肺动脉高压青年人2ndICS,RSB:aneurysmofascendingaorta胸骨右缘第二肋间:升主动脉瘤3rd,4thICS,LSB:R.Vhypertrophy胸骨左缘3,4肋间:右心室肥大xiphoidprocess:R.Vhypertrophy,abdominalaneurysm剑突下:右心室肥大腹主动脉瘤郑州大学第一附属医院PalpationoftheHeart心脏触诊apicalimpulse心尖搏动thrill震颤pericardialfrictionfremitus心包摩擦感郑州大学第一附属医院ApicalImpulse心尖搏动Clinicalsignificance:signifyingthestartofthesystolicphase临床意义:指示收缩期的开始Locationandrange:sameasininspection位置和范围:与视诊相同Increased(heave):forcefulandsustained增强:搏动持续有力liftingapicalimpulse抬举性心脏搏动Decreased:cannotpalp.clearly减弱:不能清楚触到郑州大学第一附属医院AbnormalofApicalImpulse心尖搏动异常Increasedcauses:leftventricularpressureoverloadandconsequenthypertrophy增强原因:左室内压升高和肥厚Clinicalsignificance:leftventricularhypertrophy临床意义:左心室肥大Decreasedcauses:decreasedcontractibilityofthemyocardium减弱原因:心肌收缩力减弱Clinicalsignificance:heartfailure,pericardialeffusion,myocarditis临床意义:心力衰竭心包积液心肌炎郑州大学第一附属医院Thrill震颤Mechanism:formationofbloodflowvorticescausedbyvalvestenosisorabnormalpathway.产生机制:血流旋涡引起低频较强震动由瓣膜狭窄和异常通道引起Types:systole,diastole,continuous分型:收缩期震颤舒张期震颤持续震颤Clinicalsignificance:reliablesignsoforganicheartdiseases临床意义:器质性心脏病的征象郑州大学第一附属医院ThrillinSystole收缩期震颤2ndICS,LSB:pulmonicstenosis胸骨左缘第二肋间:肺动脉瓣狭窄2ndICS,RSB:aorticstenosis胸骨右缘第二肋间:主动脉瓣狭窄3rd,4thICS,LSB:interventricularseptaldefect胸骨左缘34肋间:室间隔缺损郑州大学第一附属医院ThrillinDiastoleandContinuous舒张期和持续性震颤Diastolicthrillonapex:mitralstenosis心尖部舒张期震颤:二尖瓣狭窄Continuousthrillon2ndICS,LSB:Patentductusarteriosus胸骨左缘第二肋间连续性震颤:动脉导管未闭郑州大学第一附属医院PericardialFrictionFremitus心包摩擦感Mechanism:inflammationorirritationofthepericardium机制:心包表面粗糙Typicalsite:4thICS,LSB部位:胸骨左缘第四肋间Feeling:frictionlikeleatherrubbing感觉:如皮革相互摩擦Features:itisbestpalpatedwiththepersonsittingupandleaningforward,andwiththebreathheldinexpiration特点:坐位前倾呼气末明显与心跳一致闭气时不消失Clinicalsignificance:pericarditis意义:提示心包炎郑州大学第一附属医院PercussionoftheHeart心脏叩诊percussionoftheheartborder心界叩诊abnormaldullnessheartborder心界异常郑州大学第一附属医院PercussionTechnique叩诊方法Force:lightpercussionfortherelativedullnessborder.力量:轻叩叩出相对浊音界Position:supine:parallelthemiddlefingertointercostal;sitting:plumbthemiddlefinger.体位:仰卧位:板指与肋间平行坐位:板指与肋间垂直Steps:fromlefttoright,lowertoupper,outwardtoinward顺序:先左后右自下而上由外向内Leftborder:2~3cmfromtheapicalimpulse心左界:心尖搏动外2~3cm开始Rightborder:ICSnexttotheupperborderoftheliver心右界:肝上界上一肋间开始Measure:thedistancefromdullnessbordertoanteriormidline测量:浊音界距前正中线的垂直距离郑州大学第一附属医院NormalRelativeDullnessBorderoftheHeart正常心浊音界Distancebetweendullnessborderandanteriormidline心脏之相对浊音界距前正中线的距离Right右(cm)ICS肋间Left左(cm)2-3Ⅱ2-32-3Ⅲ3.5-4.53-4Ⅳ5-6Ⅴ7-9(thedistancebetweenleftmidclavicularlineandanteriormidlineis9cm)(左锁骨中线距前正中线9cm)郑州大学第一附属医院AbnormalBorderbyHeartVariation心脏改变引起心界异常L.Venlargement:boot-shapedheart左室扩大:靴形心L.Aenlargement:pear-shapedheart左房扩大:梨形心B.Venlargement:generalenlargedheart双室扩大:普大心R.Venlargement:corpulmonal右室扩大:先心肺心Pericardialeffusion:flask-shapedheart心包积液:烧瓶心郑州大学第一附属医院AbnormalDullnessHeartBorder心界叩诊异常chestandlungdiseases胸肺疾病Pleuraleffusionorlungconsolidation:dullnessborderundetectable胸腔积液或肺实变:叩不出Emphysema:“shrinked”dullnessborder肺气肿:心浊音界缩小abdominaldisorders腹部疾病Diaphragmelevation:acrossingheart膈升高:横位心郑州大学第一附属医院Boot-shapedHeart靴形心Mechanism:L.VenlargementFeatures:theleftborderextendstotheinferiorleft,waistoftheheartisdeepened.Causes:aorticinsufficiency,hypertensiveheartdisease机制左室扩大特点心左界向左下扩大心腰加深病因主动脉瓣关闭不全高血压心脏病郑州大学第一附属医院Pear-shapedHeart梨形心Mechanism:L.AenlargementanddistensionofpulmonaryarteryFeatures:dullnessheartborderinthe2nd,3rdICSontheLSBextendsoutside,waistoftheheartbulgesoutCauses:mitralstenosis机制左房扩大肺动脉扩大特点胸骨左缘23肋间心浊音界向外扩大心腰饱满或膨出病因二尖瓣狭窄郑州大学第一附属医院GeneralEnlargedHeart普大心Mechanism:bothleftan
本文标题:06心脏基本检查(7)
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