肺部体检课件.ppt

1、肺部体检课件1（1 1）掌握胸部常用的体表标志和人工划）掌握胸部常用的体表标志和人工划线，胸部的陷窝和分区；线，胸部的陷窝和分区；（2 2）掌握胸、肺部视诊、触诊检查方法，）掌握胸、肺部视诊、触诊检查方法，能获得较正确的结果；识别正常状态和异能获得较正确的结果；识别正常状态和异常体征；常体征；（3 3）熟悉肺部常见体征的临床意义。）熟悉肺部常见体征的临床意义。教学目的教学目的肺部体检课件胸部的体表标志胸部的体表标志骨骼标志骨骼标志自然陷窝自然陷窝一、天然标志一、天然标志二、人工划线或分区二、人工划线或分区肺部体检课件Sternal anglesubscapular angle Intercos

2、tal spaceSpinous processxiphoid Costalspinal angleSuprasternal notchManubrium sterniscapula肺部体检课件4o胸骨角：胸骨角：Louis Louis 角。两侧分别与左右第角。两侧分别与左右第2 2肋软骨连接，为肋软骨连接，为计数肋骨和肋间隙顺序的主要标志计数肋骨和肋间隙顺序的主要标志。胸骨角还标志。胸骨角还标志支气支气管分叉管分叉、心房上缘心房上缘和和上下纵隔交界上下纵隔交界及及相当于第相当于第5 5胸椎的水胸椎的水平平o腹上角：胸骨下角（腹上角：胸骨下角（infrasternal angle)infras

3、ternal angle)，相当于横膈，相当于横膈的穹窿部，正常约的穹窿部，正常约7070-110-110o肩胛下角：肩胛骨的最下端。直立位两上肢自然下垂时肩胛下角：肩胛骨的最下端。直立位两上肢自然下垂时，作为，作为第第7 7或第或第8 8肋骨水平的标志，肋骨水平的标志，或相当于或相当于第第8 8胸椎的水胸椎的水平，平，作为作为后胸部计数肋骨的标志后胸部计数肋骨的标志肺部体检课件5epigastric angle Infraclavicular fossaAnterior midlineSuprasternal fossaSupraclavicular fossaSternal linePar

4、asternal lineMidclavicular line肺部体检课件6Anterior axillary lineMidaxillary linePosterior axillary line肺部体检课件7Scapular linePosterior midlineInfrascapular regionInterscapular regionSuprascapular regionScapular region肺部体检课件8o锁骨中线（锁骨中线（midclavicular linemidclavicular line）（左、右）为通过锁）（左、右）为通过锁骨的肩峰端与胸骨端两者中点的垂

5、直线，即通过锁骨中骨的肩峰端与胸骨端两者中点的垂直线，即通过锁骨中点向下的垂直线点向下的垂直线o肩胛线（肩胛线（scapular linescapular line）（左、右）为双臂下垂时通过）（左、右）为双臂下垂时通过肩胛下角与后正中线平行的垂直线肩胛下角与后正中线平行的垂直线肺部体检课件9肺部体检课件10肺部体检课件11肺部体检课件12肺部体检课件13 表表里里 上上下下 前前后后 视、触、叩、听顺序进行视、触、叩、听顺序进行 胸部检查顺序胸部检查顺序肺部体检课件视诊（视诊（inspection)皮肤皮肤胸壁静脉胸壁静脉肋间隙肋间隙胸廓形态胸廓形态呼吸运动呼吸运动乳房乳房肺部体检课件胸壁皮

6、肤胸壁皮肤颜色、肿胀颜色、肿胀肺部体检课件胸壁静脉胸壁静脉有无充盈或曲张有无充盈或曲张上腔静脉阻塞时，静脉血流方向自上而下上腔静脉阻塞时，静脉血流方向自上而下下腔静脉阻塞时，静脉血流方向自下而上下腔静脉阻塞时，静脉血流方向自下而上如何判断胸壁静脉的血流方向？如何判断胸壁静脉的血流方向？肺部体检课件p有无回缩或膨隆有无回缩或膨隆p吸气时肋间隙回缩提示呼吸道阻塞吸气时肋间隙回缩提示呼吸道阻塞p肋间隙膨隆见于大量胸腔积液、张力性气胸、严重肺气肿肋间隙膨隆见于大量胸腔积液、张力性气胸、严重肺气肿患者用力呼气时患者用力呼气时p胸壁肿瘤、主动脉瘤、婴儿和儿童时期心脏明显肿大者，胸壁肿瘤、主动脉瘤、婴儿和儿

7、童时期心脏明显肿大者，相应局部的肋间隙常膨出相应局部的肋间隙常膨出肋间隙肋间隙肺部体检课件胸廓形态胸廓形态患者体位：坐位或立位患者体位：坐位或立位裸露全部胸廓裸露全部胸廓平静呼吸平静呼吸前、后、左、右、两侧对比视诊前、后、左、右、两侧对比视诊（1 1）两侧对称性）两侧对称性（2 2）横径与前后径比值）横径与前后径比值 1 1：1.51.5肺部体检课件Barrel chestGibbus肺部体检课件oFlat chestFlat chest：体型瘦长，慢性消耗性疾病：体型瘦长，慢性消耗性疾病oBarrel chestBarrel chest：严重肺气肿，老年或矮胖体型者：严重肺气肿，老年或矮胖体

8、型者oRachitic chestRachitic chest：佝偻病。漏斗胸（：佝偻病。漏斗胸（furnnel chestfurnnel chest）指）指胸骨剑突处显著内陷，形似漏斗。鸡胸（胸骨剑突处显著内陷，形似漏斗。鸡胸（pigeon chestpigeon chest）指胸廓的前后径略长于左右径，上下距离较短，胸骨）指胸廓的前后径略长于左右径，上下距离较短，胸骨下端常前突，胸廓前侧壁肋骨凹陷下端常前突，胸廓前侧壁肋骨凹陷o胸廓一侧变形：膨隆；平坦或下陷胸廓一侧变形：膨隆；平坦或下陷o胸廓局部隆起胸廓局部隆起o脊柱畸形脊柱畸形肺部体检课件21肺部体检课件Pectus excavatum

9、Barrel chest Kyphosis肺部体检课件231.Respiratory movementnAbdominal breathing:male adult and child nThoracic breathing:female adultnThree depressions signndyspnea肺部体检课件242.Respiratory rate:16-18 f/minnTachypnea:20 f/minnBradypnea:500ml:breathlessness,chest depress肺部体检课件51oTachypneaoLimited movement of aff

10、ected sideoCostal interspaces of affected side are wideroTrachea shifts to opposite sideoDecreased vocal fremitus oDullness or flatness oDecreased or disappeared vesicular breath sound oDecreased or disappeared vocal resonance oPleural friction rub oAbnormal bronchial breath sound in upper area of t

11、he fluid肺部体检课件52肺部体检课件53oSudden chest pain oDyspneaoForced sitting positionoUnaffected side lyingoDry coughTension pneumothoraxnProgressive dyspneanSevere sweatnTyckycardianTension,agitatednCyanosisnRespiratory failure肺部体检课件54oCostal interspaces in affected side are wideroLimited movement of affecte

12、d side oDecreased or disappeared vocal fremitus oTrachea and heart shift to opposite sideoTympanyoVesicular breath sound decreased or disappeared肺部体检课件55（1 1）胸骨角）胸骨角(sternal angle)-Louissternal angle)-Louis角的确定及意义？角的确定及意义？（2 2）肩胛下角的确定及意义？）肩胛下角的确定及意义？（3 3）锁骨中线的确定及意义？）锁骨中线的确定及意义？肺部体检课件常见异常呼吸类型的病因和特点常见

13、异常呼吸类型的病因和特点类型类型特点特点病因病因呼吸停止呼吸消失心脏停搏Biots呼吸规则呼吸后出现长周期呼吸停止又开始呼吸颅内压增高，药物引起呼吸抑制，大脑损害Cheyne-Stokes呼吸不规则呼吸呈周期性，呼吸频率和深度逐渐增加和逐渐减少以至呼吸暂停交替出现药物引起的呼吸抑制，充血性心力衰竭，大脑损伤Kussmaul呼吸呼吸深快代谢性酸中毒肺部体检课件57肺与胸膜常见疾病的体征肺与胸膜常见疾病的体征疾病疾病胸廓胸廓呼吸动度呼吸动度气管气管位置位置语音震颤语音震颤叩诊叩诊音响音响呼吸呼吸音音罗罗音音语音语音共振共振大叶性肺炎对称患侧减弱居中患侧增强肺气肿桶状双侧减弱居中双侧减弱哮喘对称双侧

14、减弱居中双侧减弱肺水肿对称双侧减弱居中正常或减弱肺不张患侧平坦患侧减弱移向患侧减弱或消失胸腔积液患侧饱满患侧减弱移向健侧减弱或消失气胸患侧饱满患侧减弱或消失移向健侧减弱或消失肺部体检课件58病例书写格式病例书写格式视诊：胸壁静脉无曲张，肋间隙无狭窄或饱满，视诊：胸壁静脉无曲张，肋间隙无狭窄或饱满，胸廓两侧对称，无畸形，呼吸运动两侧对称，胸廓两侧对称，无畸形，呼吸运动两侧对称，胸式呼吸为主，呼吸频率胸式呼吸为主，呼吸频率1818次次/分，节律规整。分，节律规整。触诊：胸壁无压痛，无皮下捻发感，胸廓扩张触诊：胸壁无压痛，无皮下捻发感，胸廓扩张度两侧对称，语音震颤两侧强度一致，无胸膜度两侧对称，语音

15、震颤两侧强度一致，无胸膜摩擦感。摩擦感。肺部体检课件Large left Hemithorax can be seen in all of the following except:1.Left pleural effusion 2.Left Pneumothorax 3.Kyphoscoliosis 4.Agenesis of right lung Questions肺部体检课件Smaller left Hemithorax can be seen in all of the following except:1.Consolidation of left lower lobe2.Atele

16、ctasis of left lung3.Left Pleural fibrosis4.Agenesis of left lung 肺部体检课件Which statement is correct in counting the Respiratory rate:1.BP,Pulse and Respiratory rate should be taken first 2.Tell the patient that you are going to count his respiraory rate before counting 3.Count it aduring examination

17、of Respiratory system steps 4.After patient is in a relaxed state count it without the patient being aware that you are counting his respiratory rate 肺部体检课件Bradypnea is seen in all of the following except:1.Brain Tumor 2.Myxedema（粘液水肿）（粘液水肿）3.Morphine overdose 4.Congestive heart failure 肺部体检课件Slow d

18、eep breathing is:1.Kussmals breathing 2.Biots respiration 3.Cheyne stokes breathing 4.Sighs 5.Sleep apnea 肺部体检课件In Congestive Heart failure following can occur except:1.Increased Respiratory rate 2.Cheyne stokes breathing 3.Platypnea 4.Orthopnea 5.Labored breathing 肺部体检课件Possible causes of unilatera

19、l diminution or delay in chest expansion include all of the following except:1.Pleural effusion 2.Asthma 3.Pulmonary consolidation 4.Pleural pain with splinting 肺部体检课件Assessment of chest expansion with deep inspiration helps identify the side of abnormality.Patient has decreased chest expansion on t

20、he left.Which is the most likely condition the patient may have:1.Emphysema/COPD 2.Bronchial asthma 3.Right pleural fibrosis 4.Left pneumothorax 5.Right lung mass 肺部体检课件Patient has consolidation of right lower lobe.You would expect:1.No change in chest expansion2.Decreased expansion of right hemithorax3.Decreased expansion of left hemithorax4.Increased expansion of left hemithorax肺部体检课件Tactile fremitis is decreased in all of the following conditions except:1.Pleural effusion 2.Pleural fibrosis 3.Pneumothorax 4.Lobar pneumonia 肺部体检课件肺部体检课件70