心脏评估-心脏检查视触叩CARDIOVASCUIAR教学提纲.ppt

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1、心脏评估-心脏检查视触叩CARDIOVASCUIAR概述introduction运用视、触、叩、听等检查方法初步判定有无心脏疾病，判断心脏病的病因、性质、部位及程度．在临床上具有重要的意义。Touseinspection,palpation,percussionandauscultationtodeterminewhetherheartdiseasesexistandwhatthecausesmaybe,thesiteandthecharactersifheartdiseasesexist.SoCARDIOVASCUIAREXAMINATION

2、hasgreatsignificance.检查的注意事项mattersneedingattentionintheexamination一般采取仰卧位或坐位；dorsalpositionorsittingpositionisoftenused;环境应安静；光线充足，最好是来源于左侧，Theenvironmentshouldbequietandbright;itwillbebetteriflightsourcecomesfromleftside;室温不低于20℃；Temperatureshouldbehigherthan20℃心脏视诊lnspect

3、ionoftheheart(一)心前区隆起与凹陷eminenceorintrocessioninprecordialregion(二)心尖搏动apicalimpulse(三)心前区异常搏动Abnormalprecordialpulsation心脏触诊Palpationoftheheart检查者常用右手，以全手掌、手掌尺侧(小鱼际)或示指、中指和无名指并拢以指腹触诊。Thewholepalm,antithenareminenceorfingertipsofRighthandisoftenusedwhenPalpation.检查震颤常用手掌尺侧，检

4、查心尖搏动常用2-4指指腹。antithenareminenceisoftenusedforthrillPalpation,whilefingertipsareoftenusedforapicalimpulsePalpationPalpationoftheheart(一)心尖搏动apicalimpulse(二)震颤:概念;产生机制Thrill:concept;mechanism(三)心包摩擦感:概念;产生机制;特点senseofpericardialfriction:concept;mechanism;character心脏叩诊Percussi

5、onoftheheart心脏叩诊用以确定心界，判定心脏大小、形状及在胸腔位置的一种方法。Percussionoftheheartisusedtofindtheborderoftheheart;相对浊音界反映心脏的实际大小,具有重要的临床意义.borderofrelativedullnesspresentthetruesizeoftheheart,soithasmoreclinicalsignificance.(二)正常心脏相对浊音界thenormalborderofrelativedullnessRightborder（cm）intercost

6、alspaceLeftborder（cm）2-32-33-4IIIIIIVV2–33.5–4.55-67-9听诊auscultation用膜型胸件听诊Auscultatewithdiaphragm•肺动脉瓣区（胸骨左缘第2肋间隙）•主动脉瓣区（胸骨右缘第2肋间隙）•主动脉瓣第二听诊区（胸骨左缘第3、4肋间隙）•二尖瓣区（心尖部）•三尖瓣区（胸骨左缘第4、5肋间隙或胸骨体下端稍偏右）•Pulmonaryarea(secondleftICS)•Aorticarea(secondrightICS)•Secondaorticarea(thi

7、rdandfourthleftICS)•Mitralarea(Apicalarea)•Tricuspidarea(fourth,fifthleftICS,LSBandRSB)听诊auscultation用钟型胸件听诊Auscultatewithbell•肺动脉瓣区•主动脉瓣区•主动脉瓣第二听诊区•二尖瓣区•三尖瓣区•Pulmonaryarea•Aorticarea•Secondaorticarea•Mitralarea(Apicalarea)•Tricuspidarea心脏瓣膜听诊区auscultatorycardiacval

8、veareas与各瓣膜的解剖位置并不完全一致。cardiacvalvesarenotexactlylocatedintheauscult