妇科病史及体格检查【推荐-】

1、妇科病史及体格检查 广州中医药大学第二临床医学院妇科教研室引言应用“四诊调查了解疾病的发生、开展、演变和治疗转归，从掌握的病史资料中“以外测内、见证推病，以常衡变到达认识病症的属性与病位的浅深、病势的进退，邪正的盛衰，标本的传变以及预后和吉凶。问诊?千金要方?“未诊先问?景岳全书?“问诊，乃诊治之要领，临证之首务也问诊 1年龄：不同的年龄阶段有不同的生理特点和易发疾病2主诉：从患者所述病情中归纳出来的主要证象或最痛苦的典型病症。 要求精练、确切问诊主诉患“卵巢囊肿病5年普查发现子宫增大3个月 停经60天，腹痛2天，阴道流血13天 下腹时有隐痛、时有腰酸1个月，并见带下增多，上症近3个月加重 问

2、诊现病史3现病史指发病始至应诊时疾病的发生、开展和治疗的全过程。对诊断和鉴别诊断疾病，判断预后，确定治疗方案甚为重要。问诊现病史 一般以主诉为核心，按时间顺序描述，并记明起病的诱因，病情缓急，病症的特点，出现的具体时间、部位、性质、持续的时间和程度，有无伴随病症，疾病开展与变化过程，曾否经过治疗及其具体治疗措施、治疗效果及反响等。对有鉴别意义的有关病症，即使为阴性也应写入现病史中。此外，还需问明患者的一般情况，如寒热、纳寐、二便、精神状态、体重变化等。 问诊现病史月经停闭：年龄、婚否、性生活情况、避孕方式、是否哺乳、有无情志创伤或环境改变，是否患有他病或手术史。阴道流血：了解末次月经情况，必要

3、时追问再上一次月经。询问量、色、质、气味、持续时间、有无腹痛、有无组织物排出。带下异常：量、色、质、气味、持续时间、有无腹痛、有无阴痒。 问诊现病史与妊娠有关的病证：有无呕吐、阴道流血、腹痛、水肿、小便不通或小便淋漓等。与产褥有关的病证：有无腹痛、恶露异常、阴道出血、发热、缺乳或乳汁自出、二便异常或身痛、汗出不止等。腹痛与腹部包块：了解起病时间、发病部位、持续时间与病势缓急，有无停经史、外伤史，发热及阴道出血情况，与月经有无关系。问诊现病史不孕症：同居年限，既往孕史及避孕情况，丈夫健康状况，既往诊治情况。伴随月经周期或绝经前后出现的病症：持续的时间，病势的轻重，是偶病还是每次必病，能否自行缓解

4、消失。 问诊4月经史：初潮年龄、月经周期、经期、经量及经质情况。经期有无伴随病症，末次月经时间，绝经年龄。5带下：量、色、质、气味、持续时间、有无腹痛、有无阴痒。6婚产史：结婚年龄、配偶年龄及健康，孕产情况，节育措施。 问诊7既往史：了解与现病有关的病史，以往的健康状况，治疗经过，有无药物过敏等。8家族史：父母、兄妹及子女的健康状况，有无遗传病及传染病等。9个人生活史：生活嗜好、卫生习惯、居住环境、工作性质、平素性情、夫妇感情等。 望诊 ?灵枢?云：“视其外应，以知其内脏，测知所病矣。1望形神 形是神志存在的根底，神是形体生命活动的表现。通过眼神及面部神情而知。2望面色 面部颜色和光泽的变化，

5、可以反映脏腑气血盛衰和邪气消长的情况。望诊3望唇舌 望口唇 口唇的颜色、润燥等变化主要反映脾胃的情况。望舌质 舌为心之苗窍，但五脏六腑通过经络、经筋都直接或间接与舌相联，脏腑精气均上荣于舌，故脏腑的病变都反映于舌。望舌苔 舌苔的颜色，可察病变之寒热；舌苦的厚薄，可辨邪气之深浅；苔的润燥，可验津液之盛衰。望诊4望月经：经色、量、质。5望带下 带下量多，是属病态，临证必当详辨其色、质情况。6望恶露：重在观察量、色、质变化。7望形态：高矮胖瘦，骨肉是否结实，肌肤是否润泽。8第二性征和腹部观察：第二性征主要观察乳房及发育情况、外生殖器是否正常。9腹部是否膨隆、有无疤痕等。闻诊 1耳听声音 听患者的语音

6、、呼吸、嗳气、叹息、痰喘、咳嗽等声音，帮助判断病在何脏何腑，属虚属实。2鼻嗅气味 了解病体及病室气味，以辨阴阳、寒热。在妇科主要是了解月经、带下、恶露等气味。切诊 是医生用双手对病人体表进行触、摸、按、压从而获得异常体征，为辨证提供资料的一种诊察方法。切诊脉诊月经脉：脉多见滑，或弦滑略数带下脉妊娠脉：脉多滑利，按之不绝临产脉：尺脉滑利而急数，此称“离经脉产后脉：新产之初可见浮滑或滑数，或虚数略滑之脉。以后逐渐为虚缓和平之脉。切诊按诊四肢腹部包括妇科检查及孕期腹部检查 盆腔切诊 是了解、诊断妇科疾病的主要方法与重要依据。检查器械包括无菌手套、阴道窥器、棉签、消毒液、石蜡油。盆腔切诊盆腔切诊盆腔切

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