常见呼吸系统疾病症状体征

1、常见呼吸系统疾病症状体征常见呼吸系统疾病症状体征一、以大叶分布的肺脏炎性病变，病理改变分为三期，充血期、实变期、消散期。Lobrpneumoniisdefinedsninfectionoflungprenchymwithlobrdistributionofconsolidtion.Itspthologiclchngescouldbedividedintothreestges,whichincludecongestion,consolidtionndresolution.症状SymptomsXX壮年，诱因，起病急Youngdultswithmotivtion,suddenonset.寒颤、高热、

2、胸痛、咳嗽、铁锈色痰Chills,highfever,chestpin,cough,rustysputum.体征signs急性热病容，呼吸困难，口唇疱疹。Fceofcuteillndfever,dyspne,herpeslbilis视诊：呼吸动度减弱Inspection:decreseofrespirtorymovement触诊：语音振颤增强，气管居中Plption:increseofvoclfremitus,trcheinmiddleposition扣诊：浊音Percussion:dullness听诊：管状呼吸音，胸膜摩擦音，湿罗音usculttion:bronchilbrethsound,

3、pleurlfrictionrub,rles.二、慢性堵塞性肺病(chronicobstructivepulmonrydiseseCOPD)慢性堵塞性肺病是一种具有气流受限特征的肺部疾病，气流受限不完全可逆，呈进行性进展。确切的病因还不十分清楚，但认为与肺部对有害气体或有害颗粒的异常炎症反应有关。COPDhsbeendefinedsdisesechrcterizedbythepresenceofirflowlimittion,whichisprtillyreversiblendgenerllyprogressive.TheexctcuseofCOPDstillreminsuncler,butm

4、ostlyisssocitedwithbnormllypulmonryinflmmtoryresponsetothehrmfulgsesorprticles.症状：Symptoms慢性咳嗽，咳痰，白色粘液泡沫痰，合并感染时可为脓性,冬季加剧.Chronicproductivecough,whitishmucoidfrothysputum,yellowishsputumwhencomplictedwithinfection.ggrvtioninthewinter,气短或呼吸困难,喘息shortofbrethordyspne,wheezing,dyspnewithexertion.体征：signs

5、1. 视诊:胸廓呈桶状，肋间隙增宽，呼吸动度减弱Inspection:brrelchest,decreseofrespirtorymovement2. 触诊：语颤减弱Plption:decreseofvoclfremitus.3. 叩诊：双肺叩诊呈过清音，肺下界下降，心界缩小，肝浊音界下移Percussion:bilterlhyperresonnce4. 听诊：肺泡呼吸音减弱，散在干湿罗音usculttion:decreseofbrethsoundsnddiffusedrhonchindrles三、支气管哮喘（bronchilsthm）是由多种细胞（如嗜酸性粒细胞，肥大细胞，T细胞，中性粒细胞

6、，气道上皮细胞等）和细胞组分参与的气道慢性炎症性疾病。这种慢性炎症导致气道反应性增加，通常出现广泛多变的可逆性气流受限，并引起反复发作性的喘息，气急，胸闷或咳嗽等症状，常在夜间和（或）清晨发作，加剧，多数患者可自行缓解Bronchil sthm is或经治疗缓解。chronicinflmmtorydisorderoftheirwyinwhichmnycellsndcellulrcomponentsplyrole,inprticulrmstcells,eosinophils,T-lymphocytes,neutrophils,epithelilcellsndsoforth.Thischronic

7、inflmmtioncusesirwyhyperresponsivenessndrecurrentepisodesofwheezing,brethlessness,chesttightness,ndcough,prticulrlytnightnd/orintheerlymorning.Thesesymptomsreusullyssocitedwithwidespredbutvribleirwylimittionthtisreversibleeitherspontneouslyorwithtretment.症状Symptoms1. 幼年或XX年期发病，反复发作，季节性。Childhoodordo

8、lescenceonset,recurrentttcksndsesonlity.2. 过敏原接触史，过敏性鼻炎症状Contctofllergen,llergicrhinitis3. 胸闷，带有哮鸣音的呼气性呼吸困难Chesttightness,expirtorydyspnewithwheezing4. 症状可经治疗缓解或自行缓解Remissionspontneouslyorwithtretment.体征Signs1. 视诊：呼气性呼吸困难，被迫端坐位，辅助呼吸肌参与呼吸，大汗，紫绢，胸廓饱满，呈吸气位。Inspection:expirtorydyspne,forcedsittingpositi

9、on,ccessoryrespirtorymuscleuse,sweting,cynosis,chesthyperinfltion.2. 触诊：呼吸动度变小，语颤减弱Plption:decreseofrespirtorymovementndfremitus.3. 叩诊：过清音Percussion:hyperresonntnote4. 听诊：两肺满布干罗音usculttion:diffusedrhonchi.四、胸腔积液(pleurleffusion)胸膜毛细血管内静水压增高，胶体渗透压降低或胸膜毛细血管通透性增加所致胸膜液体产生增多或汲取减少，使胸膜腔内积聚的液体较正常为多。胸腔积液的性质可分

10、为渗出液和漏出液。Pleurleffusionisdefinedsthebnormlccumultionoffluidwithinthepleurlspce.Itmybecusedbyneitherexcessfluidproductionordecresedbsorption,whichressocitedwithincresedpleurlcpillrieshydrostticpressureordecresedoncoticpressureorincresedpleurlcpillriespermebility.Thechrcterofpleurlfluidcnbedividedinto

11、exudtesndtrnsudte.症状：Symptoms1. v300ml症状不明显Thesymptomsrenotobviouswhenthefluidislessthn300ml2. 干咳，胸痛。胸液增多时胸痛减轻Drycough,pleuriticchestpin,thepinwillbepllitedwhenthefluidincrese3. >500ml气短、胸闷shortbrethndchesttightnesswhenthefluidisover500ml4. 大量胸腔积液呼吸困难、发组dyspnendcynosiswhenthefluidislrge.5. 基础疾病症状

12、symptomsofthebsicdisese.体征Signs1 .少量胸液常无体征Usullythereisnosignsifthefluidis<500ml2 .中至大量积液Middletolrgefluid视诊：呼吸受限，肋间饱满Inspection:restrictionoftherespirtorymovementontheffectedside,bulgingintercostlsmrgins触诊：心尖搏动及气管移向健侧，语颤减弱Plption:shiftofpexbetndtrchetotheuninvolvedside.bsenttctilefremitusovereff

13、usion叩诊：积液区浊音或实音Percussion:dullnessontheeffusionre.听诊：积液区呼吸音减弱或消逝，积液区上方可听到支气管呼吸音，纤维索性胸膜炎可听到胸膜摩擦音usculttion：Decresedorbsentbrethsoundsovertheeffusion.Bronchilbrethsoundscouldbeherdbovethepleurleffusion.pleurlrubcouldbeherdindryorfibrinouspleurisy五、气胸(pneumothorx)空气进入胸腔.irinthepleurlspce根据病因可分为；Cnbecl

14、ssifiedsfollowsccordingtothecustivefctors1. 自发性气胸：堵塞性肺气肿、肺结核等spontneouspneumothorx:COPD,pulmonrytuberculosis.2. 人工气胸：rtificilpneumothorx3. 外伤性气胸：trumticpneumothorx根据胸膜破裂的情况，临床分为；clssifiedclinicllysfollowsccordingtothepleurlhole1. 闭合性closedpneumothorx2. 交通性openpneumothorx3. 张力性tensionpneumothorx.症状Sy

15、mptoms1. 诱因：motivtion(strenuousexertion)2. 突发一侧胸痛伴呼吸困难suddenonsetwithunilterlpleuriticpinnddyspne.Thedegreeofdyspnevriesccordingtothesizeofthepneumothorxndthelungshelthycondition3. 患者基础肺功能好，小量闭合性气胸，仅有轻度气急，数小时后可逐渐平稳smllclosedpneumothorxwithgoodbsiclungfunction,theinitildyspneisslightndwillimprovefter

16、fewhours.4. 大量张力性气胸严峻呼吸困难，同时可有呼吸循环衰竭的表现lrgetensionpneumothorxwillproduceseverdyspnendevenrespirtoryorcircultoryfilure体征Signs1 .少量胸腔积气常无明显体征noobvioussignsifpneumothorxissmll2 .大量积气lrgepneumothorx视诊：患侧胸廓饱满，肋间隙变宽，呼吸动度减弱Inspection:theffectedthorcicisfullndtherespirtorymovementisrestricted.触诊：气管、心脏移向健侧，语

17、颤减弱或消逝Plption:trchelndpexbetdevition,voclfremitusdiminishedordisppered.叩诊：患侧呈鼓音.Percussion:hyper-resonnceonpercussion听诊：患侧呼吸音减弱或消逝usculttion:diminutionofbrethsounds.肺不张(telectsis)肺泡容积减少lossoflveolrvolume1. 堵塞性肺不张obstructivetelectsis异物、肿瘤、痰拴、支气管内膜结核等foreignbody,neoplsm,sputumplug,endobronchiltubercul

18、osis2. 非堵塞性肺不张non-obstructivetelectsis压缩性（气胸、积液）compressive,e.g.pneumothorx,pleurleffusion症状Symptoms:与肺不张的范围、程度相关vriesccordingtotheextentnddegreeoftelectsis.呼吸困难、咳嗽，继发感染时有相应的中毒症状dyspne,cough,toxicsymptomssocitedwithsecondryinfection.体征Signs:视诊：患侧胸廓塌陷，呼吸动度减弱Inspection:retrctionoftheinvolvedsidendtherespirtorymovementisrestricted.触诊：心脏、气管移向患侧，语颤减弱，压缩性肺不张语颤可增强Plpti