婦科病史及體格檢查【推薦-】

1、婦科病史及體格檢查 廣州中醫(yī)藥大學(xué)第二臨床醫(yī)學(xué)院婦科教研室引言應(yīng)用“四診調(diào)查了解疾病的發(fā)生、開展、演變和治療轉(zhuǎn)歸，從掌握的病史資料中“以外測內(nèi)、見證推病，以常衡變到達(dá)認(rèn)識病癥的屬性與病位的淺深、病勢的進(jìn)退，邪正的盛衰，標(biāo)本的傳變以及預(yù)后和吉兇。問診?千金要方?“未診先問?景岳全書?“問診，乃診治之要領(lǐng)，臨證之首務(wù)也問診 1年齡：不同的年齡階段有不同的生理特點(diǎn)和易發(fā)疾病2主訴：從患者所述病情中歸納出來的主要證象或最痛苦的典型病癥。 要求精練、確切問診主訴患“卵巢囊腫病5年普查發(fā)現(xiàn)子宮增大3個月 停經(jīng)60天，腹痛2天，陰道流血13天 下腹時有隱痛、時有腰酸1個月，并見帶下增多，上癥近3個月加重 問

2、診現(xiàn)病史3現(xiàn)病史指發(fā)病始至應(yīng)診時疾病的發(fā)生、開展和治療的全過程。對診斷和鑒別診斷疾病，判斷預(yù)后，確定治療方案甚為重要。問診現(xiàn)病史 一般以主訴為核心，按時間順序描述，并記明起病的誘因，病情緩急，病癥的特點(diǎn)，出現(xiàn)的具體時間、部位、性質(zhì)、持續(xù)的時間和程度，有無伴隨病癥，疾病開展與變化過程，曾否經(jīng)過治療及其具體治療措施、治療效果及反響等。對有鑒別意義的有關(guān)病癥，即使為陰性也應(yīng)寫入現(xiàn)病史中。此外，還需問明患者的一般情況，如寒熱、納寐、二便、精神狀態(tài)、體重變化等。 問診現(xiàn)病史月經(jīng)停閉：年齡、婚否、性生活情況、避孕方式、是否哺乳、有無情志創(chuàng)傷或環(huán)境改變，是否患有他病或手術(shù)史。陰道流血：了解末次月經(jīng)情況，必要

3、時追問再上一次月經(jīng)。詢問量、色、質(zhì)、氣味、持續(xù)時間、有無腹痛、有無組織物排出。帶下異常：量、色、質(zhì)、氣味、持續(xù)時間、有無腹痛、有無陰癢。 問診現(xiàn)病史與妊娠有關(guān)的病證：有無嘔吐、陰道流血、腹痛、水腫、小便不通或小便淋漓等。與產(chǎn)褥有關(guān)的病證：有無腹痛、惡露異常、陰道出血、發(fā)熱、缺乳或乳汁自出、二便異?；蛏硗?、汗出不止等。腹痛與腹部包塊：了解起病時間、發(fā)病部位、持續(xù)時間與病勢緩急，有無停經(jīng)史、外傷史，發(fā)熱及陰道出血情況，與月經(jīng)有無關(guān)系。問診現(xiàn)病史不孕癥：同居年限，既往孕史及避孕情況，丈夫健康狀況，既往診治情況。伴隨月經(jīng)周期或絕經(jīng)前后出現(xiàn)的病癥：持續(xù)的時間，病勢的輕重，是偶病還是每次必病，能否自行緩解

4、消失。 問診4月經(jīng)史：初潮年齡、月經(jīng)周期、經(jīng)期、經(jīng)量及經(jīng)質(zhì)情況。經(jīng)期有無伴隨病癥，末次月經(jīng)時間，絕經(jīng)年齡。5帶下：量、色、質(zhì)、氣味、持續(xù)時間、有無腹痛、有無陰癢。6婚產(chǎn)史：結(jié)婚年齡、配偶年齡及健康，孕產(chǎn)情況，節(jié)育措施。 問診7既往史：了解與現(xiàn)病有關(guān)的病史，以往的健康狀況，治療經(jīng)過，有無藥物過敏等。8家族史：父母、兄妹及子女的健康狀況，有無遺傳病及傳染病等。9個人生活史：生活嗜好、衛(wèi)生習(xí)慣、居住環(huán)境、工作性質(zhì)、平素性情、夫婦感情等。 望診 ?靈樞?云：“視其外應(yīng)，以知其內(nèi)臟，測知所病矣。1望形神 形是神志存在的根底，神是形體生命活動的表現(xiàn)。通過眼神及面部神情而知。2望面色 面部顏色和光澤的變化，

5、可以反映臟腑氣血盛衰和邪氣消長的情況。望診3望唇舌 望口唇 口唇的顏色、潤燥等變化主要反映脾胃的情況。望舌質(zhì) 舌為心之苗竅，但五臟六腑通過經(jīng)絡(luò)、經(jīng)筋都直接或間接與舌相聯(lián)，臟腑精氣均上榮于舌，故臟腑的病變都反映于舌。望舌苔 舌苔的顏色，可察病變之寒熱；舌苦的厚薄，可辨邪氣之深淺；苔的潤燥，可驗(yàn)津液之盛衰。望診4望月經(jīng)：經(jīng)色、量、質(zhì)。5望帶下 帶下量多，是屬病態(tài)，臨證必當(dāng)詳辨其色、質(zhì)情況。6望惡露：重在觀察量、色、質(zhì)變化。7望形態(tài)：高矮胖瘦，骨肉是否結(jié)實(shí)，肌膚是否潤澤。8第二性征和腹部觀察：第二性征主要觀察乳房及發(fā)育情況、外生殖器是否正常。9腹部是否膨隆、有無疤痕等。聞診 1耳聽聲音 聽患者的語音

6、、呼吸、噯氣、嘆息、痰喘、咳嗽等聲音，幫助判斷病在何臟何腑，屬虛屬實(shí)。2鼻嗅氣味 了解病體及病室氣味，以辨陰陽、寒熱。在婦科主要是了解月經(jīng)、帶下、惡露等氣味。切診 是醫(yī)生用雙手對病人體表進(jìn)行觸、摸、按、壓從而獲得異常體征，為辨證提供資料的一種診察方法。切診脈診月經(jīng)脈：脈多見滑，或弦滑略數(shù)帶下脈妊娠脈：脈多滑利，按之不絕臨產(chǎn)脈：尺脈滑利而急數(shù)，此稱“離經(jīng)脈產(chǎn)后脈：新產(chǎn)之初可見浮滑或滑數(shù)，或虛數(shù)略滑之脈。以后逐漸為虛緩和平之脈。切診按診四肢腹部包括婦科檢查及孕期腹部檢查 盆腔切診 是了解、診斷婦科疾病的主要方法與重要依據(jù)。檢查器械包括無菌手套、陰道窺器、棉簽、消毒液、石蠟油。盆腔切診盆腔切診盆腔切

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