心脏体检上课用课件.ppt
《心脏体检上课用课件.ppt》由会员分享,可在线阅读,更多相关《心脏体检上课用课件.ppt(130页珍藏版)》请在三一办公上搜索。
1、1,Department of Diagnostics1st Affiliated Hospital Chen Ming,Physical examination of heart,2,Equipment(器材):Stethoscope(听诊器);Position(体位):Supine(卧位)or seated(坐位)a patient;standing to the right side of the patient(an examiner);Environment(环境):Quiet(安静);Exposure(暴露):Strip to waist(腰部);Lightening(光线):Go
2、od;left side;tangent(切线);Knowledge of anatomy(解剖知识):thorough(全面)Considerate and gentle。,Physical examination of heart(心脏检查)Preparation,3,Midsternal line(胸骨中线)or Anterior midline(前正中线)Midclavicular lines(锁骨中线)Anterior,middle,and posterior axillary lines(腋前、中、后线)Sternal angle(胸骨角)-connected with 2th c
3、ostal cartilage(与第二肋软骨相连)Intercostal space(肋间隙),Physical examination of heart(心脏检查)landmarks of topographic anatomy(解剖标志),4,Inspection(望诊),Palpation(触诊),Percussion(叩诊),Auscultation(听诊),心 脏 检 查,Physical examination of heart(心脏检查),5,Tangent lightening(切线方向光线);Same height as thorax(与胸廓同高)。,Inspection(望
4、诊)-gist(要点),6,Precordial prominence(心前区隆起):Right ventricular hypertrophy at puberty(儿童发育完成前右心室肥大)Congenital heart disease(先天性心脏病)Rheumatic heart disease(风湿性心脏病)Massive pericardial effusion in the adult(成人大量心包积液)。,Inspection(望诊)-Deformity of thoraxes(胸廓畸形),7,Inspection(望诊)-Apical impulse(心尖搏动),Defini
5、tion(定义):Heart contracts(心脏收缩)impacts corresponding site of front chest(心尖向前冲击前胸壁相应位置)apical impulse(心尖搏动)。,8,Inspection(望诊),Normal apical impulse(正常心尖搏动):Location-The 5th intercostal space(第五肋间),0.5 1.0 cm medial to left midclavicular line(左锁骨中线内侧 0.5 1.0 cm);Diameter-2.0 2.5 cm。,Inspection(望诊)-Api
6、cal impulse(心尖搏动),9,Physiological factors(生理性因素):Left lateral position(左侧卧位)-extend to the left(向左移)for 2.0 3.0 cm.Right lateral position(右侧卧位)-extend to the right(向右移)for 1.0 2.5 cm.,Inspection(望诊)-Displacement of apical impulse(心尖搏动移位),10,Pathological factors(病理性因素):Heart itself(心脏本身)Enlargement o
7、f left ventricle(左 心室增大)-extend to left and downwards(左下移位);,Inspection(望诊)-Displacement of apical impulse(心尖搏动移位),11,Pathological factors(病理性因素):Heart itself(心脏本身)Enlargement of right ventricle(右 心室增大)-extend to left but not downwards(向左不向下移位);Enlargement of both ventricles(左 右室均增大)-extend to both
8、left and right.,Inspection(望诊)-Displacement of apical impulse(心尖搏动移位),12,Pathological factors(病理性因素):Displacement of mediastinum(纵隔移 位)Pleural adhesion(胸膜粘连),pulmonary atelectasis of one side(肺 不张-displacement of apical impulse toward the diseased side(移向 患侧);Pleural effusion(胸腔积液),pneumothorax of o
9、ne side(气胸)-displacement of apical impulse toward the opposite side(移向健侧).,Inspection(望诊)-Displacement of apical impulse(心尖搏动移位),13,Pathological factors(病理性因素):Displacement of diaphragm(横隔移位)Massive ascites(大量腹水),huge tumor of abdominal cavity(腹腔巨大 肿瘤)-displacement of apical impulse to left(移向左侧);Se
10、vere emphysema(肺气肿)-displacement of apical impulse inward and downward(移向内下)。,Inspection(望诊)-Displacement of apical impulse(心尖搏动移位),14,Physiological factors(生理性因素):Thick chest wall(胸壁肥厚)-weak and narrow(减弱、缩小);Thin chest wall(胸壁薄)-strong and wide(增强、较大)。,Inspection(望诊)-Changes of intensity and range
11、 in apical impulse(心尖搏动强度与范围的改变),15,Pathological factors(病理性因素):Increase in intensity of apical impulse(心尖搏动增强)-fever(发热),anemia(贫血),hyperthyroidism(甲状腺机能亢进);Decrease in intensity of apical impulse(心尖搏动减弱)-dilated cardiomyopathy(扩张型心肌病),acute myocardial infarction(急性心肌梗死),pericardial effusion(心包积液),
12、emphysema(肺气肿)。,Inspection(望诊)-Changes of intensity and range in apical impulse(心尖搏动强度与范围的改变),16,Inspection(望诊)-Inward impulse(负性心尖搏动),Definition(定义):invagination(内陷)of apical impulse when contracting。Significance(意义):adhesive pericarditis(粘连性心包积液)。,17,Inspection(望诊)-precordial impulse(心前区搏动),Impuls
13、e at 3th 4th left intercostal space just lateral to sternum(胸骨左 缘3 4肋间):right ventricular hypertrophy(右室肥 大);Impulse at xiphoid process(剑突下搏 动):right ventricular hypertrophy;beating of abdominal aorta(腹主动脉搏 动).,18,Impulse at base of heart(心底部搏动):2nd left intercostal space just lateral to sternum(胸骨左
14、缘2肋间):dilation of pulmonary artery;pulmonary hypertension.2nd right intercostal space just lateral to sternum(胸骨右缘2肋间):dilation of ascending aorta(升主动 脉扩张)。,Inspection(望诊)-precordial impulse(心前区搏动),19,Inspection(望诊)-contents(内容),Deformity of thoraxes(胸廓畸形)Apical impulse(心尖搏动)Precordial impulse(心前区搏动
15、),20,Palpation(触诊)Importance of palpation(触诊意义),To confirm the observations made during inspection(进一步证实望诊所见);To detect invisible pulsatile movements(发现望诊看不见的搏动);To reveal thrill and pericardial friction rubs(发现震颤和心包摩擦感)。,21,Palpation(触诊)-method(方法),Right palm first(先用右手手掌)-detecting thrills(检查震颤);F
16、ingertips then(后用指尖)-detecting pulsations(检查搏动)。,22,Definition(定义):Slow and forceful beat in apex(心尖区徐缓、有力的搏动),lift finger tip(可使手指尖端抬起)。Significance(意义):Sign of left ventri-cular hypertrophy(左室肥大的体征)。,Palpation(触诊)-heaving apex impulse(抬举样心尖搏动),23,Palpation(触诊)-thrills(震颤),Definition(定义):Tiny vibra
17、tions felt by palm(手掌感觉到的一种细小震动感),somewhat similar to the sensations on the throat of a purring cat,therefore also called purring(与在猫喉部摸到的呼吸震颤类似,故亦称猫喘)。Mechanism:The same as cardiac murmurs(同杂音)。,24,Significance(意义):Signs of organic heart diseases(器质性心脏病的体征);always Thrill-cardiac murmur,not always C
18、ardiac murmur-thrill;Usually-congenital heart disease(先天性心脏病)、valvular stenosis(瓣 膜狭窄),seldom valvular regurgi-tation(关闭不全)。,Palpation(触诊)-thrills(震颤),25,Palpation(触诊)-thrills(震颤),Clinical importance of thrills at apex(心前区震颤的临床意义)Location(部位)Phase(时相)Disease 2nd right intercostal systole(收缩期)aortic
19、space just lateral to stenosissternum(胸骨右缘2肋间)(主动脉瓣狭窄)2nd left intercostal systole(收缩期)pulmonary space just lateral to stenosis sternum(胸骨左缘2肋间)(肺动脉瓣狭窄)3th-4th left intercostal systole(收缩期)ventricularspace just lateral to septal defectsternum(胸骨左缘3-4肋间)(室间隔缺损)2nd left intercostal continuous(连续性)pate
20、nt ductusspace just lateral to arteriosussternum(胸骨左缘2肋间)(动脉导管未闭)Apex(心尖区)diastole(舒张期)mitral stenosis(二尖瓣狭窄),26,Palpation(触诊)-pericardial friction rubs(心包摩擦感),Definition(定义)Acute pericarditis(急性心包炎)Fibrin effuses from pericardium(心包膜纤维素渗出)Roughness of peri-cardium(心包粗糙)Visceral and parietal pericar
21、dial surfaces rub against each other when heart beats(心脏搏动时脏层与壁层心包摩擦)Pericardial friction rubs(心包摩擦感)。,27,Palpation(触诊)-pericardial friction rubs(心包摩擦感),Features to and fro grating sensation;both in systole and diastole;best sensed at apex or 3th 4th left intercostal space just lateral to sternum;cl
22、earer if patients lean against forward;disappear:pericardial effusion.,28,Palpation(触诊)-contents(内容),Apical impulse and heaving apex impulse(心尖搏动和抬举样心尖搏动)Thrills(震颤)Pericardial friction rubs(心包摩擦感),29,Percussion(叩诊),Aim(目的):To detect size of heart and its contour(确定心界大小及形态)。,30,Percussion(叩诊),Relati
23、ve and absolute dullness of the heart,31,Percussion-method of percussion(叩诊方法),Use mediate percussion(间接叩诊);In recumbent position(仰卧体位);Place pleximeter parallel with intercostal space when patient is in recumbent position(当病人仰卧位,板 指与肋间隙平行);,32,Percussion-method of percussion(叩诊方法),Compare percussio
24、n note of each intercostal space from lateral aspect inwards,from lower part upwards(从外向内,从下向上逐一肋间隙比较叩诊 音);,33,Heart and great vessels give absolute dullness on percussion(心脏和大血管叩诊为绝对浊音),and the parts of heart overlaid by lung give relative dullness on percussion(心脏被肺遮盖部分叩诊为相对浊音)which re-presents re
25、al size and shape of heart(代表心脏的真实大小和形态)。,Percussion-method of percussion(叩诊方法),34,Percussion-method of percussion(叩诊方法),Percussion of the right margin of the heart(心右界的叩诊):Begins from the intercostal space one interspace higher than the border of liver dullness(叩诊从肝浊音界上一肋间开始);Carry out upwards inte
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- 心脏 体检 上课 课件
链接地址:https://www.31ppt.com/p-3854592.html