血管评估双语.pptVIP

一、血管检查ExaminationoftheVesselsExaminationMethodsInspectionPalpationPercussionAuscultationExaminationofthePeripheralVesselsIncludingPulseArterialBloodPressureVascularMurmurPeripheralVesselSign部位1浅表动脉：桡动脉(Radial)颈动脉(Carotid)2方法(Palpation)3食指、中指、环指指腹平放、双侧4内容5脉率、脉律、紧张度6动脉壁弹性、强弱、波形变化7一、脉搏(Pulse)（一）脉率(PulseRate)正常：成人：60~100bpm婴幼儿：130bpm异常：短绌脉(PulseDeficit)：房颤增快：发热、甲亢减慢：药物、病窦(SickSinusSyndrome)hl:Detectintheupperandlowerextremities（二）脉律(PulseRhythm)生理：吸：?呼：?窦性心律不齐(SinusArrhythmia)病理：绝对不齐：房颤联脉：二联脉三联脉脱落脉(DroppedPulse)：房室传导阻滞(AVB)动脉硬化(arteriosclerosis)（索条迂曲、结节状）04动脉壁状态(ArterialWallStatus)05Peripheralpulsearepalpated,theirsymmetryandtheelasticityoftheunderlyingarterialwallarenoted.01血压（收缩压）影响03紧张度(Tensity)02hl:（三）紧张度与动脉壁状态强弱(Strength)影响心排血量(CO)、脉压(PP)、外周血管阻力(PVR)分类(Classification)洪脉(BoundingPulse)：高热、甲亢、主动脉瓣关闭不全细脉(microsphygmia)：主动脉瓣狭窄、心力衰竭、休克（五）波形(UndulateForm)1、正常2、水冲脉3、交替脉4、奇脉5、无脉hl:Seventypicalandmonwaveforms1、正常(NormalWave)升支（扣击波Ascendingbranch）左室收缩早期?主动脉壁波峰（潮波Spike）左室收缩中晚期、部分血流逆反?主动脉壁降支（重搏波Descendingbranch）左室舒张期?主动脉瓣关闭血流持续流向外周外周折回近端后又向前主动脉壁弹性回缩见于：明显动脉硬化，重博波不明显02将其前壁臂高举过头?感知水冲的脉搏意义：主动脉瓣关闭不全、甲亢、严重贫血、动脉导管未闭03hl:Indisorderswithrapidrunoffofarterialblood,pulsewillhavearapidupstrokeandthencollapse.特点：骤起骤落，如潮水涨落方法：紧握患者手腕掌面，012、水冲脉(WaterHammerPulse)交替脉(PulsusAlternans)特点：节律正常、强弱交替意义：左室收缩强弱交替高血压性心脏病、急性心肌梗死、主动脉瓣关闭不全、左心室衰竭。4、奇脉(ParadoxicalPulse)机制：正常：吸气回心血量??systolicBPdecreaseupto10mmHgCO不变?脉搏不变肺血容量??异常：吸气回心血量??dropofSBPisgreaterthannormalCO??脉搏?或消失肺血容量??收缩压：吸气呼气10mmHg以上（吸停脉）4、奇脉(ParadoxicalPulse)意义：缩窄性心包炎(ConstrictivePericarditis)