胸廓和肺部体格检查课件

胸廓和肺部体格检查

chestandpulmonaryphysicalexaminationChestExamination

胸廓检查landmarksonthechestwall

胸部体表标志及分区chestshapeandwall

胸廓与胸壁breast

乳房LandmarksontheChestWall

胸壁骨髂标志(前)Clavicle

锁骨Manubrium

胸骨柄Manubriosternaljunction(AngleofLouis)

胸骨角Ribandintercostalspace

肋骨和肋间隙3LandmarksontheChestWall

胸壁骨髂标志(后)Spinousprocess

脊柱棘突Costovertebralangle

肋脊角Scapula

肩胛骨Inferiorangleofscapula

肩胛下角4ReferenceLinesinFront

胸部体表标志线(前)Midsternalline

前正中线Midclavicularline

锁骨中线5ReferenceLinesinLateral

胸部体表标志线(侧)Anterioraxillaryline

腋前线Midaxillaryline

腋中线Posterioraxillaryline

腋后线6ReferenceLinesinBack

胸部体表标志线(后)Scapularline

肩胛线Vertebralline

后正中线7FossasandRegions

胸部四窝和背部四区Fossas:胸部凹陷suprasternalfossa

胸骨上窝supraclavicularfossa

锁骨上窝

infraclavicularfossa

锁骨下窝axillaryfossa

腋窝Regions:背部分区scapularregion

肩胛区suprascapularregion

肩胛上区infrascapularregion

肩胛下区interscapularregion

肩胛间区ChestWall

胸壁检查Visibleveins:collateralcirculation,payattentiontothedirectionofbloodflow

静脉显露:侧枝循环注意血流方向‘Grippingsnow’sensation:subcutaneousemphysema

皮肤握雪感:皮下气肿Regionalenlargement:ribfracture,tumoronthechestwall,cardiacenlargement

局部膨隆:肋骨骨折胸壁肿瘤心脏增大Localtenderness:inflammation,ribfracture

局部压痛:胸壁炎症肋骨骨折Sternumtendernessandpercussionpain:leukemia

胸骨压痛叩击痛:白血病AbnormalIntercostalSpace

肋间隙改变Recessedornarrowed凹陷或变窄（容积缩小）depressedwheninspiration:airwayobstruction

吸气时凹陷:大气道阻塞one-sidedepression:atelectasis,pleuraladhesion

一侧变窄凹陷:肺不张胸膜粘连Wideorswelling

膨隆或增宽（容积增大）generalintensewhenexpirating:emphysema,bronchialasthma

呼气时膨隆:肺气肿支气管哮喘one-sideintense:pleuraleffusion,pneumothorax

一侧增宽膨隆:胸腔积液气胸Chestshape

胸廓形态Normal:Ap:T=1:1.5正常形态:前后径:横径＝1:1.5Abnormal:形态异常:FlatchestandBarrelchest

扁平胸和桶状胸Rachiticchest:Pigeonchest,Rachiticrosary,Funnelchest,Harrisongroove

佝偻病胸:鸡胸串珠胸漏斗胸肋膈沟Regionaltransfiguration

局部变形Thorax-vertebrae-malformation-induced

胸椎严重畸形ApTFlatchestandBarrelChestDeformity

扁平胸和桶状胸Anterior-posteriordiameterofchestshapeincreasedandequaltotransverse

胸廓前后径增大等于横径Intercostalwiderandribflattenout

肋间增宽走向变平13PigeonandFunnelChestDeformity

鸡胸和漏斗胸14BreastExamination

乳房检查Galactophoreanatomise:breastandnipple,regionallymphnodes

乳腺解剖

乳房与乳头邻近淋巴结Breastsubarea:upperandlower,outerandinner

乳房分区

外上与外下内下与内上Breastexamination:inspectionandpalpation

乳房检查

视诊与触诊15InspectionofBreastsContour

乳房轮廓视诊Normal:symmetrichemisphere

对称半球形Asymmetric

不对称enlarged:inflammation,tumor

增大:炎症肿瘤under-sized:hypogenesis

缩小:发育不良16InspectionofBreastSkin

乳房皮肤视诊Redness:inflammation

发红

炎症Peaud’orange(orangepeel):malignancy

桔皮样水肿

恶性肿瘤Retraction:scar,tumor

回缩下陷

瘢痕肿瘤orangepeelretraction17Nippleretraction

乳头回缩Bilateralandlifelong:hypogenesis

双侧长期:发育异常Unilateralandrecent:inflammationandmalignancy

单侧近期:炎症肿瘤Indrawingofthenipple18NippleDischarge

乳头分泌物非哺乳期

无分泌物哺乳期

乳白色非哺乳期分泌物血性

乳腺癌脓性

乳腺炎淡黄色

乳腺导管病变PalpationoftheBreasts

乳房触诊Technique:examinewiththeflatofthehandandtipsofthefingers

检查手法:用指腹或手掌轻压滑动Order:fromhealthtodisasterside

检查顺序:先健侧后患侧upper,lower,outer,inner

外上→外下→内下→内上20PalpationMethodoftheBreasts

乳房触诊检查方法Onemanualpalpation

单手触诊Bimanualpalpation

双手触诊21PalpationofRegionalNodes

淋巴结触诊检查方法PathologicalFindings

触诊异常改变Skin:Increasedconsistency,Diminishedelasticity,Tenderness

皮肤:硬度增加弹性消失压痛Masses:LocationandsizeContour,margin,rigidity;Tenderness,mobility

包块:部位与大小外形边缘硬度压痛活动度Lymphadenovarix:Axillary,Suprasternalfossa

淋巴结:腋窝锁骨上窝淋巴结增大CommonDiseases

乳腺常见病变Acutemastadenitis

急性乳腺炎Cystichyperplasia

乳腺囊性增生Fibroma

乳腺纤维瘤Cancer

乳腺癌Gynecomastiainthemale

男性乳房增生gynecomastia24PulmonaryPhysicalExamination

肺部体格检查inspection,palpationandpercussion

视诊触诊叩诊TheLungInspection

肺部视诊Sizeandshapeofthorax

胸廓与肺的外形

Respiratoryfrequency

呼吸频率Depthandrhythm

呼吸深度和节律

Respiratorymovement

呼吸运动SizeandShapeofThorax

胸廓与肺外形Lungvolumevariation:barrelchest,flatchest

肺容积改变:

桶状胸扁平胸Chestmalformation:rachiticchest,kyphosis,coliosis

胸廓畸形:佝偻病胸驼背脊柱侧凸27RespiratoryFrequency

呼吸频率Normalrespiratoryrate:

正常:12~20次/分Bradypnea:ratelessthan12perminute

呼吸过缓:＜12次/分Tachypnea:rategreaterthan24perminute

呼吸过速:＞20次/分ImportantPatternofBreathing

重要呼吸节律类型Kussmals

酸中毒深大呼吸Sleepapnea

睡眠呼吸暂停Cheynestrokes

潮式呼吸Pursedlipbreathing

缩唇呼吸Orthopnoea:shortofbreathinsupineposition,getssomereliefbysittingorstandingup端坐呼吸:平卧时气短坐起或站立呼吸困难可缓解RespiratoryMovement

呼吸运动Normal:Symmetric

正常:对称胸腹式呼吸Enhancedordecreased,unilateralorbilateral

呼吸增强或减弱单侧或双侧Inspiratorydyspnea,‘threedepressionssign’

吸气性呼吸困难“三凹征”Expiratorydyspnea,protractionofintercostal

呼气性呼吸困难肋间隙膨隆呼气延长EffortofVentilation

用力呼吸Personappearsuncomfortable.Breathingseemsvoluntary

病人呼吸不适主动用力呼吸Accessorymusclesareinuse,expiratorymusclesareactiveandexpirationisnotpassiveanymore

辅助肌用力呼气肌收缩Thedegreeofnegativepleuralpressureishigh

胸腔压力升高Therespiratoryrateisincreased

呼吸频率加快TheLungPalpation

肺部触诊Chestexpansion

胸廓扩张度Trachealposition

气管位置Pleuralfrictionfeelings

胸膜摩擦感Vocal(tactile)fremitus

语音震颤ChestExpansion

胸廓扩张度Comparebilateraldynamiceventsofrespiration

测定双侧呼吸动度33AbnormalChestExpansion

胸廓扩张度异常Asymmetricalchestexpansionisabnormal

胸廓扩张度不对称提示异常Theabnormalsideexpandslessandlagsbehindthenormalside

胸廓扩张度减小一侧为病变侧Anyformofunilaterallungorpleuraldiseasecancauseasymmetryofchestexpansion

肺或胸膜疾病均可引起对侧代偿性增强Globalexpansiondecreaseindicatediffuselungorpleuraldisease

双侧胸廓扩张度减小提示

两肺弥漫病变双侧胸腔积液TrachealPosition:Mediastinum

气管位置:提示纵隔位置被检者取坐位或仰卧位右手的示指与环指置于两侧胸锁关节中指置于气管上观察中指是否位于示指与环指中间35AbnormalTrachealPosition

气管位置异常Anydeviationofthemediastinumisabnormal

提示纵隔位移异常Pull:(Lossoflungvolume)Atelectasis,fibrosis,agenesis,surgicalresection,pleuralfibrosis

移向患侧(肺容积缩小)肺不张肺纤维化胸膜粘连Push:(Spaceoccupyinglesions)pleuraleffusion,pneumothorax,largemasslesions

推向健侧(胸腔容积增大)胸腔积液气胸巨大占位Mediastinalmassesandthyroidtumors

纵隔或甲状腺肿瘤PleuralFrictionFeelings

胸膜摩擦感Mechanism:pleuralsurfaceroughness

机制:胸膜表面粗糙Feelingfrictionlikeleatherrubbingbybreathing

随呼吸感觉到如皮革相互摩擦Touchinventro-locationofthethorax

胸廓下前侧部位易触及Asignofacutepleuritis

提示胸膜炎Tactile

Fremitus

语音震颤Principle:wavefromtractalongthelungandpleuraltothechestwall

机制:声波→气道→肺泡→胸膜腔→胸壁振动→手掌Influencefactor:laryngealbulk,respiratoryopen,conductivemediumanddistance

影响因素:喉音大小气道通畅传导介质传导距离38Technique

检查方法Fromuppertolower

自上而下Fromprothoraxtoback

由前至后Contrastalternation

交替对比39PathologicalConditions

异常改变Weakenordisappear:Obstructiveatelectasis,emphysema,Pleuraleffusion,pneumothorax,subcutaneousemphysema

减弱或消失:阻塞性肺不张肺气肿胸腔积液气胸皮下气肿Enhanced:Consolidationoflungtissue:lobarpneumonia,pulmonaryinfarction.Largecavityinthelung,esp.nearthepleura:lungabscess,cavernouspulmonarytuberculosis

增强:肺实变:大叶肺炎肺血栓栓塞近胸膜肺空洞:肺脓肿肺结核空洞TheLungPercussion

肺部叩诊Percussionnote

叩肺音Lungborder

叩肺界Diaphragmaticexcursion

叩肺下界移动度Techniques

叩诊方法Mediatepercussion

间接叩诊法Fromuppertolower,fromoutertoinner

自上而下由外向内Prothoraxalongintercostal,backinlevel

前胸沿肋间叩后背水平叩42PercussionNotesoftheLung

肺部叩诊音Normalchest:resonance

正常:肺部清音Inferior>superior,left>right,anterior>posterior

下＞上左＞右前胸＞后背Dullnessifthelungoverlapswithneighboringorgan(liverandheart)

与邻近脏器(心脏和肝脏)重叠:相对浊音Influencingfactors:Chestwallthicknessandairinthelung

影响因素:胸壁厚度肺内含气量PathologicalPercussionNotes

病理性叩诊音Dullness

浊音Volumereduction:pneumonia,TB,atelectasis,lungedema

肺含气量减少:炎症实变肺肿瘤肺不张Flatness

实音

Airlesstissue:lungtumor,lungabcess,pleuraleffusion

胸膜(腔)胸壁增厚:

胸腔积液胸膜肥厚MASSTBfluidHyperresonance

过清音Lungtoleranceincrease:emphysema

肺内含气量增加:肺气肿Tympany

鼓音Gasinpleuralcavity:pneumothorax

胸膜腔气体:气胸Cavernousinthelungs

肺部空洞

LungBorder

叩诊肺界Kronig’sisthmus: