呼吸循环系统体格检查.doc

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1、physicalexamination心脏检查(1)CardiacExaminationninspection视诊npalpation触诊npercussion叩诊nauscultation听诊一.Theprojectionoftheheartattheanteriorchestwall.二.Theauscultatoryareaofcardialvalvesandthedirectionofthebloodflowthroughthevariousvalves1.Themitralvalvearea:Thebloodflowpassfromtheposterasuper

2、iortotheanterainferiorleft---theauculatoryareaisatapexarea.三、Precordium:n1.Thesuperiorborderisbelowtheleftthirdintercostalspacen2.Therightborderisatthemidsternumlinen3.Theleftborderisattheleftmidclavicularlinen4.TheinferiorborderisabovethediaphragmTheheartexaminationInspectionoftheHeart心脏

3、视诊Thefocalpointofinspectioninclude:nprecordiumshapen心前区外形nnormalapicalimpulsen正常心尖搏动nabnormalapicalimpulsen异常心尖搏动nprecordialabnormalimpulsen心前区异常搏动PrecordiumShape心前区外形Precordialbulge心前区隆起nFeatures:bonybulge特点:骨骼突起nClinicalimportance:Congenitalheartdiseasewithrightventricularenlargement提示:

4、先天性心脏病右室大Precordialfullness心前区饱满nFeatures:intercostalregionfullness特点:肋间软组织外突nClinicalimportance:massofpericardialeffusion提示:大量心包积液NormalApicalImpulse正常心尖搏动n一、InspectionnInmostpersons,onecansee,synchronouswithcardicsystolic,anoutwardmovementofasmallportionoftheleftchestwallcausedbythebeat

5、ofthecardicapex.Thisisthecardicorapeximpulse.nItshouldbestudiedwiththepatientuprightandlyinginvariouspositionsinceinmanyinstancestheimpalsemaybefairlydiffuseNormalApicalImpulse正常心尖搏动nLocation:the5thintercastalspace0.5~1.0cminsidetheleftmidclavicularline.nRange:2~2.5cmnDirection:outwardwhe

6、nventricularsystolebeginsanditcoincidewiththeleftcardicbordern位置:第5肋间左锁骨中线内0.5~1cmn范围:2~2.5cmn方向:收缩时向外搏动n意义:提示心尖位置代表收缩期提示心脏大小与心脏的左缘一致AbnormalApicalImpulse异常心尖搏动(1)Abnormallocation位置改变nPhysical:posture,pregnancy,etc.生理因素:体位妊娠nHeartdiseases心脏病变L.VandB.Venlargement:inferiorleft左室或双室扩大:左下移位R.

7、Venlargement:left右室扩大:向左移位nChestandabdominaldiseases肺部或腹部疾病AbnormalApicalImpulse异常心尖搏动(1)nWhenalargeamountoffluidorairispresentintherightpluralcivitywillshiftthehearttowardtheleft;ifalargeamountofairorfluidintheleftpluralcavity,willdisplacethehearttowardtheright.nRe