心臟檢查

CARDIOVASCUIAREXAMINATION

課堂目標(biāo)

learningoblectives說(shuō)出正常心尖搏動(dòng)的位置和范圍Tostatetherangeandsiteofapicalimpulse

闡述震顫的概念、產(chǎn)生機(jī)制及臨床意義Toelaborate

theconcept,mechanismandclinicalsignificanceofthrill

描述正常心臟相對(duì)濁音界的范圍Todescribetheborderofrelativedullness說(shuō)出心臟瓣膜聽(tīng)診區(qū)的概念及位置Tostatetheconceptandsiteofauscultatorycardiacvalveareas

比較S1、S2心音的產(chǎn)生機(jī)制、特點(diǎn)與臨床意義TocomparethedifferencebetweenS1andS2abouttheirmechanism,characterandclinicalsignificance陳述雜音的概念與分級(jí)Tostatetheconceptandgradeofheartmurmurs概述

introduction

運(yùn)用視、觸、叩、聽(tīng)等檢查方法初步判定有無(wú)心臟疾病，判斷心臟病的病因、性質(zhì)、部位及程度．在臨床上具有重要的意義。Touseinspection,palpation,percussionandauscultationtodeterminewhetherheartdiseasesexistandwhatthecausesmaybe,thesiteandthecharactersifheartdiseasesexist.SoCARDIOVASCUIAREXAMINATIONhasgreatsignificance.檢查的注意事項(xiàng)

mattersneedingattentionintheexamination

一般采取仰臥位或坐位；dorsalpositionorsittingpositionisoftenused;環(huán)境應(yīng)安靜；光線充足，最好是來(lái)源于左側(cè)，Theenvironmentshouldbequietandbright;itwillbebetteriflightsourcecomesfromleftside;室溫不低于20℃；Temperatureshouldbehigherthan20℃心臟視診

lnspectionoftheheart

(一)心前區(qū)隆起與凹陷eminenceorintrocessioninprecordialregion

(二)心尖搏動(dòng)apicalimpulse(三)心前區(qū)異常搏動(dòng)Abnormalprecordialpulsation

心臟觸診

Palpationoftheheart檢查者常用右手，以全手掌、手掌尺側(cè)(小魚(yú)際)或示指、中指和無(wú)名指并攏以指腹觸診。Thewholepalm,antithenareminenceorfingertips

ofRighthandisoftenusedwhenPalpation.檢查震顫常用手掌尺側(cè)，檢查心尖搏動(dòng)常用2-4指指腹。antithenareminenceisoftenusedforthrillPalpation,whilefingertipsareoftenusedforapicalimpulsePalpationPalpationoftheheart(一)心尖搏動(dòng)apicalimpulse(二)震顫:概念;產(chǎn)生機(jī)制Thrill:concept;mechanism(三)心包摩擦感:概念;產(chǎn)生機(jī)制;特點(diǎn)senseofpericardialfriction:concept;mechanism;character心臟叩診

Percussionoftheheart

心臟叩診用以確定心界，判定心臟大小、形狀及在胸腔位置的一種方法。Percussionoftheheartisusedtofindtheborderoftheheart;相對(duì)濁音界反映心臟的實(shí)際大小,具有重要的臨床意義.borderofrelativedullnesspresentthetruesizeoftheheart,soithasmoreclinicalsignificance.(二)正常心臟相對(duì)濁音界

thenormalborderofrelativedullness

Rightborder（cm）intercostalspaceLeftborder（cm）2-32-33-4IIIIIIVV2–33.5–4.55-67-9聽(tīng)診

auscultation

用膜型胸件聽(tīng)診Auscultatewithdiaphragm

?肺動(dòng)脈瓣區(qū)（胸骨左緣第2肋間隙）

?主動(dòng)脈瓣區(qū)（胸骨右緣第2肋間隙）

?主動(dòng)脈瓣第二聽(tīng)診區(qū)（胸骨左緣第3、4肋間隙）

?二尖瓣區(qū)（心尖部）

?三尖瓣區(qū)（胸骨左緣第4、5肋間隙或胸骨體下端稍偏右）

?Pulmonaryarea(secondleftICS)

?Aorticarea(secondrightICS)

?Secondaorticarea(thirdandfourthleftICS)

?Mitralarea(Apicalarea)

?Tricuspidarea(fourth,fifthleftICS,LSBandRSB)

聽(tīng)診診auscultation用鐘型胸件聽(tīng)聽(tīng)診Auscultatewithbell?肺動(dòng)動(dòng)脈瓣瓣區(qū)??主主動(dòng)脈脈瓣區(qū)區(qū)??主動(dòng)動(dòng)脈瓣瓣第二二聽(tīng)診診區(qū)??二二尖瓣瓣區(qū)??三三尖瓣瓣區(qū)?Pulmonaryarea??Aorticarea??Secondaorticarea??Mitralarea(Apicalarea)??Tricuspidarea心臟瓣瓣膜聽(tīng)聽(tīng)診區(qū)區(qū)auscultatorycardiacvalveareas與各瓣瓣膜的的解剖剖位置置并不不完全全一致致。cardiacvalvesarenotexactlylocatedintheauscultatorycardiacvalveareas.心臟瓣瓣膜聽(tīng)聽(tīng)診區(qū)區(qū)為四四個(gè)瓣瓣膜五五個(gè)區(qū)區(qū)。Wehavefourvalvesbutfiveauscultatorycardiacvalveareas心臟瓣瓣膜聽(tīng)聽(tīng)診區(qū)區(qū)auscultatorycardiacvalveareas心音音cardiacsounds心音有有四個(gè)個(gè)，第第一心心音(S1)，，第二二心音音(S2),第第三心心音(S3)和和第四四心音音(S4)。Fourkindsofcardiacsounds:S1,S2,S3,S4通常只只能聽(tīng)聽(tīng)到S1和和S2，在在某些些健康康兒童童和青青少年年也可可聽(tīng)到到S3。S4般般聽(tīng)不不到，，如能能聽(tīng)到到可能能為病病理性性。S1andS2canbeheardinallpeople,S3canbeheardinsomehealthychildrenandteenager,butS4isoftenhaspathologicalsignificance.S1ands2S1比比S2響亮亮;S1islouderthanS2;S1與與S2的產(chǎn)產(chǎn)生機(jī)機(jī)制ThemechanismofS1andS2;心臟臟雜雜音音cardiacmurmurs產(chǎn)生機(jī)機(jī)制;mechanism特點(diǎn)Character分級(jí):6級(jí)級(jí)Grade:Ⅰ~ⅥⅥ心包摩摩擦音音pericardi