最新H心脏检查C_PPT课件教学讲义ppt.ppt

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1、H心脏检查C_PPT课件AuscultationofMurmurs心脏杂音听诊mechanisms产生机制characterization听诊要点clinicalmeaning临床意义Mechanisms杂音产生机制turbulentflow→vortices→murmur湍流→旋涡→杂音Stenosisorinsufficiencyofvalves瓣膜狭窄或关闭不全Abnormalpathway(shunt)异常通道(分流)Floatingmaterialsincirculation心腔内漂浮物Stenosisordilationofbloodvessels血

2、管腔扩大或狭窄Enhancedbloodflowvelocity血流加速Diminishedviscosity血液粘度降低BothPhaseandContinuesMurmur双期杂音与连续性杂音Bothphasemurmur双期杂音Cause:mitralstenosisandinsufficiency疾病:二狭二闭Heartmurmurappearsinsystoleanddiastolerespectively.收缩舒张期分别出现杂音Auscultation:QualitydifferentandS2still特点:杂音性质可不同不遮盖第二心音Contin

3、uesmurmur连续性杂音Cause:Patentductusarteriosus疾病:动脉导管未闭Startsinsystole,continueswithoutinterruptionthroughS2intodiastole.跨越收缩期和舒张期Auscultation:QualitysameandS2disappear.特点:杂音性质相同遮盖第二心音PitchandQuality杂音性质Pitch:dependsonpressureandrateofbloodflow音调:与血流的压力和流速相关high,mediumandlow高调中等低调Quality

4、:dependsondegreeofvalvecompromise,forceofcontractionsandbloodvolume音色:与瓣膜状况收缩力和血容量相关Harshorraspy粗糙或刺耳Machine-likevibratory机器样Musical乐音样Blowing吹风样Rumbling隆隆样signingsound叹气样(泼水样)Warblesound鸟鸣样(鸥鸣鸽鸣雁鸣)Intensity杂音强度Influencingfactors:影响因素Degreeofchangebetweencalibersofthepassagesthroughw

5、hichthebloodisflowing通道口的大小Degreeofpressuredifferentialbetweenthepassages通道两端的压力差Speedofthebloodflow血流速度Thicknessofthetissuesbetweentheheartandthesurfaceofthechest传导距离IntensityofSystolicMurmur收缩期杂音强度GradeⅠ:barelyaudibleinquietroom1级:仔细听方可听到GradeⅡ:quietbutclearlyaudible2级:容易听到但不响亮Grad

6、eⅢ:moderatelyloud3级:较响亮GradeⅣ:loud,associatedwiththrill4级:粗糙且响亮伴传导震颤GradeⅤ:veryloud,thrilleasilypalpable5级:震耳GradeⅥ:veryloud,audiblewithstethoscopenotincontactwithchest,thrillpalpableandvisible6级:离开胸壁亦可闻及ConfigurationorShape杂音形态Typesofintensityvariety杂音强度变化类型Crescendo:increasinginten

7、sity递增型:强度逐渐增加Decrescendo:decreasingintensity递减型:强度逐渐减小Crescendo-decrescendo:递增递减型:强度先增加后减小Continuous:连续型:收缩期增强到舒张期减弱Plateau:sameintensity一贯型:强度大体保持一致TransmissionorRadiation杂音传导Thegreatestfactorinfluencingradiationisintensity随距离增加响度减弱性质不变Radiationdirectioncanbeinfluencedby:originofth

8、emurmur,dire