心臟檢查專(zhuān)題知識(shí)講座

課堂目標(biāo)

learningoblectives說(shuō)出正常心尖搏動(dòng)位置和范圍Tostatetherangeandsiteofapicalimpulse

闡述震顫概念、產(chǎn)生機(jī)制及臨床意義Toelaborate

theconcept,mechanismandclinicalsignificanceofthrill

描述正常心臟相對(duì)濁音界范圍Todescribetheborderofrelativedullness說(shuō)出心臟瓣膜聽(tīng)診區(qū)概念及位置Tostatetheconceptandsiteofauscultatorycardiacvalveareas

比較S1、S2心音產(chǎn)生機(jī)制、特點(diǎn)與臨床意義TocomparethedifferencebetweenS1andS2abouttheirmechanism,characterandclinicalsignificance陳說(shuō)雜音概念與分級(jí)Tostatetheconceptandgradeofheartmurmurs心臟檢查專(zhuān)題知識(shí)講座第1頁(yè)概述

introduction

利用視、觸、叩、聽(tīng)等檢驗(yàn)方法初步判定有沒(méi)有心臟疾病，判斷心臟病病因、性質(zhì)、部位及程度．在臨床上含有主要意義。Touseinspection,palpation,percussionandauscultationtodeterminewhetherheartdiseasesexistandwhatthecausesmaybe,thesiteandthecharactersifheartdiseasesexist.SoCARDIOVASCUIAREXAMINATIONhasgreatsignificance.心臟檢查專(zhuān)題知識(shí)講座第2頁(yè)檢驗(yàn)注意事項(xiàng)

mattersneedingattentionintheexamination

普通采取仰臥位或坐位；dorsalpositionorsittingpositionisoftenused;環(huán)境應(yīng)平靜；光線充分，最好是起源于左側(cè)，Theenvironmentshouldbequietandbright;itwillbebetteriflightsourcecomesfromleftside;室溫不低于20℃；Temperatureshouldbehigherthan20℃心臟檢查專(zhuān)題知識(shí)講座第3頁(yè)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

心臟檢查專(zhuān)題知識(shí)講座第4頁(yè)心臟觸診

Palpationoftheheart檢驗(yàn)者慣用右手，以全手掌、手掌尺側(cè)(小魚(yú)際)或示指、中指和無(wú)名指并攏以指腹觸診。Thewholepalm,antithenareminenceorfingertips

ofRighthandisoftenusedwhenPalpation.檢驗(yàn)震顫慣用手掌尺側(cè)，檢驗(yàn)心尖搏動(dòng)慣用2-4指指腹。antithenareminenceisoftenusedforthrillPalpation,whilefingertipsareoftenusedforapicalimpulsePalpation心臟檢查專(zhuān)題知識(shí)講座第5頁(yè)P(yáng)alpationoftheheart(一)心尖搏動(dòng)apicalimpulse(二)震顫:概念;產(chǎn)生機(jī)制Thrill:concept;mechanism(三)心包摩擦感:概念;產(chǎn)生機(jī)制;特點(diǎn)senseofpericardialfriction:concept;mechanism;character心臟檢查專(zhuān)題知識(shí)講座第6頁(yè)心臟叩診

Percussionoftheheart

心臟叩診用以確定心界，判定心臟大小、形狀及在胸腔位置一個(gè)方法。Percussionoftheheartisusedtofindtheborderoftheheart;相對(duì)濁音界反應(yīng)心臟實(shí)際大小,含有主要臨床意義.borderofrelativedullnesspresentthetruesizeoftheheart,soithasmoreclinicalsignificance.心臟檢查專(zhuān)題知識(shí)講座第7頁(yè)(二)正常心臟相對(duì)濁音界

thenormalborderofrelativedullness

Rightborder（cm）intercostalspaceLeftborder（cm）2-32-33-4IIIIIIVV2–33.5–4.55-67-9心臟檢查專(zhuān)題知識(shí)講座第8頁(yè)聽(tīng)診

auscultation

用膜型胸件聽(tīng)診Auscultatewithdiaphragm

?肺動(dòng)脈瓣區(qū)（胸骨左緣第2肋間隙）

?主動(dòng)脈瓣區(qū)（胸骨右緣第2肋間隙）

?主動(dòng)脈瓣第二聽(tīng)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)

心臟檢查專(zhuān)題知識(shí)講座第9頁(yè)聽(tīng)診

auscultation用鐘型胸件聽(tīng)診Auscultatewithbell

?肺動(dòng)脈瓣區(qū)

?主動(dòng)脈瓣區(qū)

?主動(dòng)脈瓣第二聽(tīng)診區(qū)

?二尖瓣區(qū)

?三尖瓣區(qū)

?Pulmonaryarea

?Aorticarea

?Secondaorticarea

?Mitralarea(Apicalarea)

?Tricuspidarea

心臟檢查專(zhuān)題知識(shí)講座第10頁(yè)心臟瓣膜聽(tīng)診區(qū)

auscultatorycardiacvalveareas

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

心臟檢查專(zhuān)題知識(shí)講座第11頁(yè)心臟瓣膜聽(tīng)診區(qū)

auscultatorycardiacvalveareas

心臟檢查專(zhuān)題知識(shí)講座第12頁(yè)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(tīng)到S1和S2，在一些健康兒童和青少年也可聽(tīng)到S3。S4般聽(tīng)不到，如能聽(tīng)到可能為病理性。S1andS2canbeheardinallpeople,S3canbeheardinsomehealthychildrenandteenager,butS4isoftenhaspathologicalsignificance.心臟檢查專(zhuān)題知識(shí)講座第13頁(yè)S1ands2S1比S2響亮;S1islouderthanS2;S1與S2產(chǎn)生機(jī)制ThemechanismofS1andS2;心臟檢查專(zhuān)題知識(shí)講座第14頁(yè)心臟雜音

cardiacmurmurs產(chǎn)生機(jī)制;mechanism特點(diǎn)Character分級(jí):6級(jí)Grade:Ⅰ~Ⅵ心