诊断学教学课件 胸部检查B.pptVIP

Method of Examination检查方法 Patient to say 1 or E 病人发音 Listen all around the chest and compare both side. 双侧对比胸部听诊 Vocal resonance increased when hearing clearly in patient whisper. 病人耳语可清楚听到为增强 Intensity decreased when hearing not clearly in patient saying normal voice. 病人通常说话听不清时为减弱 Clinical Significance临床意义 Increased vocal resonance included bronchophony, pectoriloquy, and added whispering: seen in lober pneumonia, cavity disease. 语音增强包括支气管语音 胸语音和耳语音增强: 见于大叶性肺炎 空洞病变 Egophony is a special increased vocal resonance with qualitative variation: seen in compressed lung tissue with pleural effusion. 羊鸣音是语音增强伴声音变化:见于胸腔积液上方肺受压区域 Decreased vocal resonance: seen in emphysema, obstructive atelectasis, mass, pleural effusion, pneumothorax, edema of chest wall, obesity. 语音减弱:见于肺气肿 阻塞性肺不张 肺肿块 胸腔积液 气胸 胸壁水肿 肥胖 Increased Vocal Resonance语音共振增强 Bronchophony: spoken voice changes to be more concentrated, nearer the listener’s ear, and the words are more clearly heard. Seen in solidification or compression of lung tissue 支气管语音: 肺实变 Pectoriloquy: the intensity of the spoken voice is increased, seen in solidification of lung tissue 胸语音: 大面积肺实变 Pleural Friction Rub胸膜摩擦音 Mechanism: The raw surfaces of pleura grate and may produce an audible sound resembling creaking leather. 机制: 胸膜表面粗糙产生似皮革摩擦的声音 Features: scratching, grating related to respiration, best heard at the end of inspiration phase, on lower lung near the midaxillary line. 特点: 吸气末 腋中线肺下部明显 Disappear when stop breathing, main difference to pericardial friction sound. 闭气时消失: 与心包摩擦音区分 Clinical significance: inflammation of pleura. 临床意义: 胸膜炎症 干啰音与胸膜摩擦音示意图 Pleural Rub胸膜摩擦 Normal parietal and visceral pleura glide smoothly during respiration. 正常胸膜表面光滑呼吸时无摩擦音 If the pleura is roughened due to any reason, a scratching, grating sound, related to respiration is heard. 胸膜表面粗糙可闻及与呼吸相关的摩擦音 You can hear the sound by c