胸部体格检查 诊断学课件.ppt

2. Method: ① Place the hands on the inferior and the anterior part of the chest wall on each side. （将手放于胸廓的前下侧部） ② Ask the patient to take deep breath. back 3. Characteristic: ① Usually，it is palpable at both inspiratory and expiratory period. ② When the patient hold breath, the pleural friction fremitus disappears. This is a significant feature for diagnosis. back 4.Clinical significance of pleural friction fremitus: ① It often occurs under the situation as acute pleurisy. （inflammation of the pleura） （急性胸膜炎） ② It gives a clue of pleural fluid with small quantity. （表示胸腔内存在胸水，但胸水量不多） back 4. Physical examination of lung pleura: —— Percussion ① Method of percussion ② Influencing factors for percussion ③ Percussion notes and their characteristics ④ The normal percussion note ⑤ The abnormal percussion note ① Methods of percussion: direct percussion Method: （ Technics） indirect percussion（常用） Video1 Video2 Video3 注意：间接叩诊法中三种错误的手法 ： 1.全部手指甚至整个手掌贴于胸壁。 2.右手中指叩击时停留时间过长。 3.没有使用腕关节的力量，而是用整个手臂 的力量。 ② influencing factors to percussion note The thickness of chest wall （胸壁组织的厚度） Presence of pleural effusion （胸腔积液） The air content of the lungs （肺内含气量） Alveolar tension （肺泡张力） Elasticity