双语胸部查体-修改版课件

胸部体格检查PhysicalExaminationoftheThoraxSEPT.2009胸部体格检查PhysicalExaminationof1教学目的1.掌握胸部体检方法及正常体征2.了解胸部异常体征教学目的1.掌握胸部体检方法及正常体征2第一节胸部的体表标志SurfaceAnatomyoftheThorax一、骨骼标志Bonesofthethorax第一节胸部的体表标志一、骨骼标志3双语胸部查体-修改版课件4双语胸部查体-修改版课件5双语胸部查体-修改版课件67thintercoastalspace7thintercoastalspace7二、垂直线标志Verticallinesofthethorax二、垂直线标志8Anteriormidline(Mid-Sternalline)MidclavicularlineParasternallineAnteriormidline(Mid-Sternal9双语胸部查体-修改版课件10ScapularlinePosteriormidlineScapularline11双语胸部查体-修改版课件12AnterioraxillarylinePosterioraxillarylineMid-axillarylineAnterioraxillaryline13双语胸部查体-修改版课件14三、自然陷窝和解剖区域Naturalfossaeandanatomicalregions三、自然陷窝和解剖区域15AxillaryfossaSuprasternalfossaSupraclavicularfossaAxillaryfossa16SuprascapularregionScapularregionInfrascapularregionInterscapularregionSuprascapularregion17四、肺和胸膜的界限Borderlinesofthelungsandthepleurae四、肺和胸膜的界限184thrib6thrib4thrib6thrib19PostiPosterioraxillarylineRib4thPostiPosterioraxillarylineRi2010thrib10thrib21双语胸部查体-修改版课件22第二节胸壁、胸廓和乳房检查Examinationofchestwall,thorax第二节胸壁、胸廓和乳房检查23一、胸壁（chestwall)1.静脉(veins)2.皮下气肿(subcutaneousemphysema)3.胸壁压痛(tenderness)4.肋间隙(intercostalspace)一、胸壁（chestwall)24二、胸廓(thorax)1.扁平胸(flatchest)2.桶状胸(barrelchest)3.佝偻病胸(rachiticchest)：佝偻病串珠（rachiticrosary），肋膈沟（harrison’sgroove），漏斗胸（funnelchest），鸡胸（pigeonchest）。4.胸廓一侧变形(deformation)5.胸廓局部隆起(localeminenceorprominence)6.脊柱畸形引起胸廓改变(spinalmalformation)二、胸廓(thorax)25双语胸部查体-修改版课件26ChickenbreastPectuscarinatumPigeonbreastChickenbreast27funnelchestPectusexcavatumPectusrecurvatumfunnelchest28双语胸部查体-修改版课件29第三节肺和胸膜检查Examinationoflungsandpleurae第三节肺和胸膜检查30一、视诊（inspection）（一）呼吸运动（respiratorymovement）呼吸深浅(depthofbreath)胸式呼吸(thoracicbreathing)腹式呼吸(abdominalbreathing)“三凹征”（threedepressionssign）

一、视诊（inspection）31二、触诊（palpation)1.胸廓扩张度（thoracicexpansion):二、触诊（palpation)32双语胸部查体-修改版课件33双语胸部查体-修改版课件342.语音震颤（vocalfremitus）：(palpation)即触觉语颤（tactilefremitus）.语音震颤↓：肺泡含气多，气道阻塞，胸腔积液和气胸，胸膜增厚，皮下气肿。语音震颤↑：肺实变，肺内巨大空腔。2.语音震颤（vocalfremitus）：(palpat353.胸膜摩擦感(pleuralfrictionfremitus)3.胸膜摩擦感(pleuralfrictionfrem36三、叩诊(percussion)1.TwoMethodsofPercussion

Indirect(mediate)percussionDirect(immediate)percussion三、叩诊(percussion)37RegionofpercussionandauscultationRegionofpercussionandauscu38RegionofpercussionandauscultationRegionofpercussionandauscu39肺尖叩诊

402.Percussionsound:Resonance—清音Tympany—鼓音Hyperresonance—过清音Dullness—浊音Flatness—实音2.Percussionsound:413.PercussionsoundofnormalthoraxTraube’ssemelunar--Traube’s鼓音区。Kronigisthmus—Kronig峡。肺下界—锁骨中线6肋间腋中线8肋间肩胛线10肋间可移动6~8cm。3.Percussionsoundofnormalt42双语胸部查体-修改版课件434.AbnormalpercussionsoundofthoraxTympany—空洞、气胸等Hyperresonance—肺气肿等Dullness—含气少，积液、肺炎、结核等Flatness—实音，比Dullness更进一步

4.Abnormalpercussionsoundo44四.听诊AuscultationofthelungsandpleuraNormalbreathsoundTrachealbreathsoundBronchialbreathsoundBronchovesicularbreathsoundVesicularbreathsound四.听诊45双语胸部查体-修改版课件46双语胸部查体-修改版课件472.AbnormalbreathsoundAbsentordiminishedvesicularbreathsound.Increasedvesicularbreathsound.ProlongedexpiratorysoundCoarsebreathsound.Abnormalbronchialbreathsound.Abnormalbronchovesicularbreathsound.2.AbnormalbreathsoundAbse483.Adventitioussounds:Moistrales

(bubblesound,crackles)：coarserales,mediumrales,finerales

crepitusRhonchi：wheezes(sibilantrhonchi),snoring(sonorousrhongchi)Stridor:inspirationphase,3.Adventitioussounds:Moi494.Vocalresonance（语音共振）Bronchophony—支气管语音Pectoriloquy—胸语音Egophony—羊鸣音Whispersound—耳语音4.Vocalresonance（语音共振）Bronc505.Pleuralfrictionrub(Rubs):5.Pleuralfrictionrub(Rubs51双语胸部查体-修改版课件52双语胸部查体-修改版课件53双语胸部查体-修改版课件54第四节呼吸系统常见病的主要体征第四节呼吸系统常见病的主要体征55双语胸部查体-修改版课件56双语胸部查体-修改版课件57双语胸部查体-修改版课件58胸部（呼吸系统）查体记录示例1.Thetracheaismidline.Thechestisnormalinappearance,Palpationisnormal.Thechestiscleartopercussionandauscultation胸部（呼吸系统）查体记录示例1.Thetracheais59胸部（呼吸系统）查体记录示例2.Thetracheaisdeviatedtotheleft.Thecheststructureiswithinnormallimits.Thereisdecreasedtactilefremitusontherightchestposteriorly,upthreequartersfromthebase.Thepercussionnoteisdullintheareaofdecreasedfremitus.Therearenobreathsoundsheardinthisarea.Anareaofegophonyispresentabovetheareaofdullness.胸部（呼吸系统）查体记录示例2.Thetracheais60思考题：胸部异常叩诊音有那些？各见于那些疾病？胸部正常听诊音有那些？各自有何特点？胸部异常听诊音有那些？分别见于那些疾病？肺气肿、气胸、肺炎、支气管哮喘可出现那些异常胸部体征？思考题：胸部异常叩诊音有那些？各见于那些疾病？61Thankyou!Thankyou!62胸部体格检查PhysicalExaminationoftheThoraxSEPT.2009胸部体格检查PhysicalExaminationof63教学目的1.掌握胸部体检方法及正常体征2.了解胸部异常体征教学目的1.掌握胸部体检方法及正常体征64第一节胸部的体表标志SurfaceAnatomyoftheThorax一、骨骼标志Bonesofthethorax第一节胸部的体表标志一、骨骼标志65双语胸部查体-修改版课件66双语胸部查体-修改版课件67双语胸部查体-修改版课件687thintercoastalspace7thintercoastalspace69二、垂直线标志Verticallinesofthethorax二、垂直线标志70Anteriormidline(Mid-Sternalline)MidclavicularlineParasternallineAnteriormidline(Mid-Sternal71双语胸部查体-修改版课件72ScapularlinePosteriormidlineScapularline73双语胸部查体-修改版课件74AnterioraxillarylinePosterioraxillarylineMid-axillarylineAnterioraxillaryline75双语胸部查体-修改版课件76三、自然陷窝和解剖区域Naturalfossaeandanatomicalregions三、自然陷窝和解剖区域77AxillaryfossaSuprasternalfossaSupraclavicularfossaAxillaryfossa78SuprascapularregionScapularregionInfrascapularregionInterscapularregionSuprascapularregion79四、肺和胸膜的界限Borderlinesofthelungsandthepleurae四、肺和胸膜的界限804thrib6thrib4thrib6thrib81PostiPosterioraxillarylineRib4thPostiPosterioraxillarylineRi8210thrib10thrib83双语胸部查体-修改版课件84第二节胸壁、胸廓和乳房检查Examinationofchestwall,thorax第二节胸壁、胸廓和乳房检查85一、胸壁（chestwall)1.静脉(veins)2.皮下气肿(subcutaneousemphysema)3.胸壁压痛(tenderness)4.肋间隙(intercostalspace)一、胸壁（chestwall)86二、胸廓(thorax)1.扁平胸(flatchest)2.桶状胸(barrelchest)3.佝偻病胸(rachiticchest)：佝偻病串珠（rachiticrosary），肋膈沟（harrison’sgroove），漏斗胸（funnelchest），鸡胸（pigeonchest）。4.胸廓一侧变形(deformation)5.胸廓局部隆起(localeminenceorprominence)6.脊柱畸形引起胸廓改变(spinalmalformation)二、胸廓(thorax)87双语胸部查体-修改版课件88ChickenbreastPectuscarinatumPigeonbreastChickenbreast89funnelchestPectusexcavatumPectusrecurvatumfunnelchest90双语胸部查体-修改版课件91第三节肺和胸膜检查Examinationoflungsandpleurae第三节肺和胸膜检查92一、视诊（inspection）（一）呼吸运动（respiratorymovement）呼吸深浅(depthofbreath)胸式呼吸(thoracicbreathing)腹式呼吸(abdominalbreathing)“三凹征”（threedepressionssign）

一、视诊（inspection）93二、触诊（palpation)1.胸廓扩张度（thoracicexpansion):二、触诊（palpation)94双语胸部查体-修改版课件95双语胸部查体-修改版课件962.语音震颤（vocalfremitus）：(palpation)即触觉语颤（tactilefremitus）.语音震颤↓：肺泡含气多，气道阻塞，胸腔积液和气胸，胸膜增厚，皮下气肿。语音震颤↑：肺实变，肺内巨大空腔。2.语音震颤（vocalfremitus）：(palpat973.胸膜摩擦感(pleuralfrictionfremitus)3.胸膜摩擦感(pleuralfrictionfrem98三、叩诊(percussion)1.TwoMethodsofPercussion

Indirect(mediate)percussionDirect(immediate)percussion三、叩诊(percussion)99RegionofpercussionandauscultationRegionofpercussionandauscu100RegionofpercussionandauscultationRegionofpercussionandauscu101肺尖叩诊

1022.Percussionsound:Resonance—清音Tympany—鼓音Hyperresonance—过清音Dullness—浊音Flatness—实音2.Percussionsound:1033.PercussionsoundofnormalthoraxTraube’ssemelunar--Traube’s鼓音区。Kronigisthmus—Kronig峡。肺下界—锁骨中线6肋间腋中线8肋间肩胛线10肋间可移动6~8cm。3.Percussionsoundofnormalt104双语胸部查体-修改版课件1054.AbnormalpercussionsoundofthoraxTympany—空洞、气胸等Hyperresonance—肺气肿等Dullness—含气少，积液、肺炎、结核等Flatness—实音，比Dullness更进一步

4.Abnormalpercussionsoundo106四.听诊AuscultationofthelungsandpleuraNormalbreathsoundTrachealbreathsoundBronchialbreathsoundBronchovesicularbreathsoundVesicularbreathsound四.听诊107双语胸部查体-修改版课件108双语胸部查体-修改版课件1092.AbnormalbreathsoundAbsentordiminishedvesicularbreathsound.Increasedvesicularbreathsound.ProlongedexpiratorysoundCoarsebreathsound.Abnormalbronchialbreathsound.Abnormalbronchovesicularbreathsound.2.AbnormalbreathsoundAbse1103.Adventitioussounds:Moistrales

(bubblesound,crackles)：coarserales,mediumrales,finerales

crepitusRhonchi：wheezes(sibilantrhonchi),snoring(sonorousrhongchi)Stridor:inspirationphase,3.Adventitioussounds:Moi1114.Vocalresonance（语音共振）Bronch