简易鼻病望诊精品课件

簡易鼻病望診 陽明中醫科 賴榮年主任 外 鼻 鼻根 鼻梁 鼻翼 鼻尖 前鼻孔 外鼻(external nose)形似三邊錐體，上窄下寬 鼻 腔 分為鼻前庭和固有鼻腔兩部分 鼻前庭（nasal vestibule) 由皮膚覆蓋 外側為鼻翼，內側為鼻小柱 皮膚富於皮脂腺和汗腺，又有鼻毛，故易發生 癤腫 固有鼻腔(nasal proper) 有內、外、頂、底四壁 內側壁：鼻中隔： 軟骨部：鼻中隔軟骨、大翼軟骨 骨部：篩骨垂直板、犁骨 鼻中隔偏曲 黎氏區(littles area) 外側壁 有多塊骨板，有三個突出於鼻腔、呈階梯 性狀排列的條形骨板，稱為鼻甲;各鼻甲之 間有一裂隙狀空間,稱為鼻道。 下鼻甲：為最大最長的鼻甲 中鼻甲：位於下鼻甲上方，位於篩竇內 側，是篩竇切除術的內界 上鼻甲：位於中鼻甲上方 中鼻甲 上鼻道 上鼻甲 下鼻道 中鼻道 嗅裂 鼻中隔 總鼻道 中鼻甲 中鼻道 下鼻甲 下鼻道 過敏性鼻炎 下鼻甲 臨床表現：噴嚏多，清涕，鼻塞(間歇或持續)，鼻癢(可伴有眼癢)，嗅覺減退。 檢查：黏膜蒼白血管收縮阻力增加。 黏膜水腫毛細血管通透性增加。 鼻涕增多 腺體增生，分泌旺盛。 感覺神經敏感性增強。 慢性單純性鼻炎 下鼻甲 臨床表現：鼻塞、間歇性、交替性多涕(常為黏涕) 檢查：下鼻甲腫脹； 總鼻道和鼻底黏性分泌物； 鼻甲軟而有彈性，對血管收縮劑敏感。 慢性肥厚性鼻炎 下鼻甲 臨床表現：鼻塞：較重，持續性，鼻涕不多，耳鳴、聽力減退 檢查：下鼻甲增生肥厚，不平 有粘涕或粘膿涕 下鼻甲堅實，無彈性 鼻息肉（nasal polyp) 臨床表現：固定或持續性鼻塞。 鼻分泌物增多。 耳鳴、聽力減退。 檢查：鼻甲有光滑、灰白或紅色、荔枝肉樣增生 。 鼻息肉 急性化膿性鼻竇炎 臨床表現：以鼻塞、多膿涕、頭疼為主，鼻塞(持續性，患側明顯， 嗅覺減退)，多膿涕， 頭痛、局部疼痛。 檢查：局部紅腫及壓痛。 鼻腔：中鼻甲紅腫。 嗅裂膿涕。 中鼻道膿涕。 不同類別鼻竇炎的頭痛特點 部位時間 上頜竇 面頰、上列牙午後及直立後加重 額竇 前額中午最劇，午後漸輕 篩竇 內眥及鼻根部頭痛較輕 蝶竇 眼球深部午後重 萎縮性鼻炎 臨床表現： 鼻和鼻咽部乾燥 鼻塞 頭痛 鼻出血 嗅覺障礙 惡臭 檢查： 外形：鞍鼻 鼻腔：粘膜乾燥 鼻腔寬大 有綠痂 Thank You for Your Attention 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