心脏评估-心脏检查视触叩CARDIOVASCUIAR

心脏检查CARDIOVASCUIAREXAMINATION课堂目标learningoblectives说出正常心尖搏动的位置和范围Tostatetherangeandsiteofapicalimpulse阐述震颤的概念、产生机制及临床意义Toelaboratetheconcept,mechanismandclinicalsignificanceofthrill描述正常心脏相对浊音界的范围Todescribetheborderofrelativedullness说出心脏瓣膜听诊区的概念及位置Tostatetheconceptandsiteofauscultatorycardiacvalveareas比较S1、S2心音的产生机制、特点与临床意义TocomparethedifferencebetweenS1andS2abouttheirmechanism,characterandclinicalsignificance陈述杂音的概念与分级Tostatetheconceptandgradeofheartmurmurs概述introduction运用视、触、叩、听等检查方法初步判定有无心脏疾病，判断心脏病的病因、性质、部位及程度．在临床上具有重要的意义。Touseinspection,palpation,percussionandauscultationtodeterminewhetherheartdiseasesexistandwhatthecausesmaybe,thesiteandthecharactersifheartdiseasesexist.SoCARDIOVASCUIAREXAMINATIONhasgreatsignificance.检查的注意事项mattersneedingattentionintheexamination一般采取仰卧位或坐位；dorsalpositionorsittingpositionisoftenused;环境应安静；光线充足，最好是来源于左侧，Theenvironmentshouldbequietandbright;itwillbebetteriflightsourcecomesfromleftside;室温不低于20℃；Temperatureshouldbehigherthan20℃心脏视诊lnspectionoftheheart(一)心前区隆起与凹陷eminenceorintrocessioninprecordialregion(二)心尖搏动apicalimpulse(三)心前区异常搏动Abnormalprecordialpulsation心脏触诊Palpationoftheheart检查者常用右手，以全手掌、手掌尺侧(小鱼际)或示指、中指和无名指并拢以指腹触诊。Thewholepalm,antithenareminenceorfingertipsofRighthandisoftenusedwhenPalpation.检查震颤常用手掌尺侧，检查心尖搏动常用2-4指指腹。antithenareminenceisoftenusedforthrillPalpation,whilefingertipsareoftenusedforapicalimpulsePalpationPalpationoftheheart(一)心尖搏动apicalimpulse(二)震颤:概念;产生机制Thrill:concept;mechanism(三)心包摩擦感:概念;产生机制;特点senseofpericardialfriction:concept;mechanism;character心脏叩诊Percussionoftheheart心脏叩诊用以确定心界，判定心脏大小、形状及在胸腔位置的一种方法。Percussionoftheheartisusedtofindtheborderoftheheart;相对浊音界反映心脏的实际大小,具有重要的临床意义.borderofrelativedullnesspresentthetruesizeoftheheart,soithasmoreclinicalsignificance.(二)正常心脏相对浊音界thenormalborderofrelativedullnessRightborder（cm）intercostalspaceLeftborder（cm）2-32-33-4IIIIIIVV2–33.5–4.55-67-9听诊auscultation用膜型胸件听诊Auscultatewithdiaphragm•肺动脉瓣区（胸骨左缘第2肋间隙）•主动脉瓣区（胸骨右缘第2肋间隙）•主动脉瓣第二听诊区（胸骨左缘第3、4肋间隙）•二尖瓣区（心尖部）•三尖瓣区（胸骨左缘第4、5肋间隙或胸骨体下端稍偏右）•Pulmonaryarea(secondleftICS)•Aorticarea(secondrightICS)•Secondaorticarea(thirdandfourthleftICS)•Mitralarea(Apicalarea)•Tricuspidarea(fourth,fifthleftICS,LSBandRSB)听诊auscultation用钟型胸件听诊Auscultatewithbell•肺动脉瓣区•主动脉瓣区•主动脉瓣第二听诊区•二尖瓣区•三尖瓣区•Pulmonaryarea•Aorticarea•Secondaorticarea•Mitralarea(Apicalarea)•Tricuspidarea心脏瓣膜听诊区auscultatorycardiacvalveareas与各瓣膜的解剖位置并不完全一致。cardiacvalvesarenotexactlylocatedintheauscultatorycardiacvalveareas.心脏瓣膜听诊区为四个瓣膜五个区。Wehavefourvalvesbutfiveauscultatorycardiacvalveareas心脏瓣膜听诊区auscultatorycardiacvalveareas心音cardiacsounds心音有四个，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通常只能听到S1和S2，在某些健康儿童和青少年也可听到S3。S4般听不到，如能听到可能为病理性。S1andS2canbeheardinallpeople,S3canbeheardinsomehealthychildrenandteenager,butS4isoftenhaspathologicalsignificance.S1ands2S1比S2响亮;S1islouderthanS2;S1与S2的产生机制ThemechanismofS1andS2;心脏杂音cardiacmurmurs产生机制;mechanism特点Character分级:6级Grade:Ⅰ~Ⅵ心包摩擦音pericardialfrictionsound产生机制Mechanism思考题:如何区分心包摩擦音与胸膜摩擦音？Question:howtodistinguishtheandpericardialfrictionsoundandpleuralfrictionrub