1、胸部体格检查胸部体格检查Physical Examination of the ThoraxSEPT.2009教学目的1.掌握胸部体检方法及正常体征2.了解胸部异常体征第一节第一节 胸部的体表标志胸部的体表标志Surface Anatomy of the Thorax一、骨骼标志Bones of the thorax7th intercoastal space二、垂直线标志Vertical lines of the thoraxAnterior midline(Mid-Sternal line)Midclavicular lineParasternal lineScapular linePos
2、terior midlineAnterior axillary linePosterior axillary lineMid-axillary line三、自然陷窝和解剖区域Natural fossae and anatomical regionsAxillary fossaSuprasternal fossaSupraclavicular fossaSuprascapular regionScapular regionInfrascapular regionInterscapular region四、肺和胸膜的界限Borderlines of the lungs and the pleura
3、e4th rib6th ribPostiPosterior axillary lineRib4th10th rib第二节 胸壁、胸廓和乳房检查Examination of chest wall,thorax 一、胸壁一、胸壁（chest wall)1.静脉(veins)2.皮下气肿(subcutaneous emphysema)3.胸壁压痛(tenderness)4.肋间隙(intercostal space)二、胸廓二、胸廓(thorax)1.扁平胸(flat chest)2.桶状胸(barrel chest)3.佝偻病胸(rachitic chest)：佝偻病串珠（rachitic ros
4、ary），肋膈沟（harrisons groove），漏斗胸（funnel chest），鸡胸（pigeon chest）。4.胸廓一侧变形(deformation)5.胸廓局部隆起(local eminence or prominence)6.脊柱畸形引起胸廓改变(spinal malformation)Chicken breastPectus carinatum Pigeon breastfunnel chest Pectus excavatumPectus recurvatum第三节 肺和胸膜检查Examination of lungs and pleurae一、视诊（一、视诊（insp
5、ection）（一）呼吸运动（respiratory movement）呼吸深浅(depth of breath)胸式呼吸(thoracic breathing)腹式呼吸(abdominal breathing)“三凹征”（three depressions sign）二、触诊（palpation)1.胸廓扩张度（thoracic expansion):2.语音震颤（vocal fremitus）：(palpation)即触觉语颤（tactile fremitus）.语音震颤：肺泡含气多，气道阻塞，胸腔积液和气胸，胸膜增厚，皮下气肿。语音震颤：肺实变，肺内巨大空腔。3.胸膜摩擦感(pleura
6、l friction fremitus)三、叩 诊 (percussion)1.Two Methods of Percussion Indirect(mediate)percussion Direct(immediate)percussionRegion of percussion and auscultationRegion of percussion and auscultation 肺尖叩诊2.Percussion sound:Resonance清音 Tympany鼓音 Hyperresonance过清音 Dullness浊音 Flatness实音3.Percussion sound o
7、f normal thorax Traubes semelunar -Traubes鼓音区。Kronig isthmusKronig 峡。肺下界锁骨中线6肋间 腋中线8肋间 肩胛线10肋间 可移动68cm。4.Abnormal percussion sound of thorax Tympany空洞、气胸等 Hyperresonance肺气肿等 Dullness含气少，积液、肺炎、结核等 Flatness实音，比Dullness更进一步 四.听诊Auscultation of the lungs and pleura1.Normal breath sound Tracheal breath s
8、ound Bronchial breath sound Bronchovesicular breath sound Vesicular breath sound2.Abnormal breath sound Absent or diminished vesicular breath sound.Increased vesicular breath sound.Prolonged expiratory sound Coarse breath sound.Abnormal bronchial breath sound.Abnormal bronchovesicular breath sound.3
9、.Adventitious sounds:Moist rales(bubble sound,crackles)：coarse rales,medium rales,fine rales crepitusRhonchi：wheezes(sibilant rhonchi),snoring(sonorous rhongchi)Stridor:inspiration phase,4.Vocal resonance（语音共振）Bronchophony支气管语音Pectoriloquy胸语音Egophony羊鸣音Whisper sound耳语音 5.Pleural friction rub(Rubs):第
10、四节第四节 呼吸系统常见病的主要体征呼吸系统常见病的主要体征胸部（呼吸系统）查体记录示例1.The trachea is midline.The chest is normal in appearance,Palpation is normal.The chest is clear to percussion and auscultation 胸部（呼吸系统）查体记录示例2.The trachea is deviated to the left.The chest structure is within normal limits.There is decreased tactile frem
11、itus on the right chest posteriorly,up three quarters from the base.The percussion note is dull in the area of decreased fremitus.There are no breath sounds heard in this area.An area of egophony is present above the area of dullness.思考题：胸部异常叩诊音有那些？各见于那些疾病？胸部正常听诊音有那些？各自有何特点？胸部异常听诊音有那些？分别见于那些疾病？肺气肿、气胸、肺炎、支气管哮喘可出现那些异常胸部体征？Thank you!
