心臟評(píng)估心臟檢查視觸叩CARDIOVASCUIAR

心臟檢查

CARDIOVASCUIAREXAMINATION課堂目的

learningoblectives說出正常心尖搏動(dòng)的位置和范圍Tostatetherangeandsiteofapicalimpulse論述震顫的概念、產(chǎn)活力制及臨床意義Toelaboratetheconcept,mechanismandclinicalsignificanceofthrill描畫正常心臟相對(duì)濁音界的范圍Todescribetheborderofrelativedullness說出心臟瓣膜聽診區(qū)的概念及位置Tostatetheconceptandsiteofauscultatorycardiacvalveareas比較S1、S2心音的產(chǎn)活力制、特點(diǎn)與臨床意義TocomparethedifferencebetweenS1andS2abouttheirmechanism,characterandclinicalsignificance陳說雜音的概念與分級(jí)Tostatetheconceptandgradeofheartmurmurs概述

introduction運(yùn)用視、觸、叩、聽等檢查方法初步斷定有無心臟疾病，判別心臟病的病因、性質(zhì)、部位及程度．在臨床上具有重要的意義。Touseinspection,palpation,percussionandauscultationtodeterminewhetherheartdiseasesexistandwhatthecausesmaybe,thesiteandthecharactersifheartdiseasesexist.SoCARDIOVASCUIAREXAMINATIONhasgreatsignificance.檢查的本卷須知

mattersneedingattentionintheexamination普通采取仰臥位或坐位；dorsalpositionorsittingpositionisoftenused;環(huán)境應(yīng)安靜；光線充足，最好是來源于左側(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)(小魚際)或示指、中指和無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)活力制Thrill:concept;mechanism(三)心包摩擦感:概念;產(chǎn)活力制;特點(diǎn)senseofpericardialfriction:concept;mechanism;character心臟叩診

Percussionoftheheart心臟叩診用以確定心界，斷定心臟大小、外形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)踐大小,具有重要的臨床意義.borderofrelativedullnesspresentthetruesizeoftheheart,soithasmoreclinicalsignificance.(二)正常心臟相對(duì)濁音界

thenormalborderofrelativedullnessRightborder（cm）intercostalspaceLeftborder（cm）2-32-33-4IIIIIIVV2–33.5–4.55-67-9聽診

auscultation用膜型胸件聽診Auscultatewithdiaphragm

?肺動(dòng)脈瓣區(qū)〔胸骨左緣第2肋間隙〕

?自動(dòng)脈瓣區(qū)〔胸骨右緣第2肋間隙〕

?自動(dòng)脈瓣第二聽診區(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)

聽診

auscultation用鐘型胸件聽診Auscultatewithbell

?肺動(dòng)脈瓣區(qū)

?自動(dòng)脈瓣區(qū)

?自動(dòng)脈瓣第二聽診區(qū)

?二尖瓣區(qū)

?三尖瓣區(qū)

?Pulmonaryarea

?Aorticarea

?Secondaorticarea

?Mitralarea(Apicalarea)

?Tricuspidarea

心臟瓣膜聽診區(qū)

auscultatorycardiacvalveareas與各瓣膜的解剖位置并不完全一致。cardiacvalvesarenotexactlylocatedintheauscultatorycardiacvalveareas.心臟瓣膜聽診區(qū)為四個(gè)瓣膜五個(gè)區(qū)。Wehavefourvalvesbutfiveauscultatorycardiacvalveareas心臟瓣膜聽診區(qū)

auscultatorycardiacvalveareas心音

cardiacsounds心音有四個(gè)，第一心音(S1)，第二心音(S2),第三心音(S3)和第四心音(S4)。Fourkindsofcardiacsounds:S1,S2,S3,S4通常只能聽到S1和S2，在某些安康兒童和青少年也可聽到S3。S4般聽不到，如能聽到能夠?yàn)椴±硇?。S1andS2canbeheardinallpeople,S3canbeheardinsomehealthychildrenandteenager,butS4isoftenhaspathologicalsignificance.S1ands2S1比S2響亮;S1islouderthanS2;S1與S2的產(chǎn)活力制ThemechanismofS1andS2;心臟雜音

cardiacmurmurs產(chǎn)活力制;mechanism特點(diǎn)Character分級(jí):6級(jí)Gr