最新[医学]心脏检查C-药学医学精品资料.ppt

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1、最新[医学]心脏检查C-药学医学精品资料AuscultationofMurmurs心脏杂音听诊mechanisms产生机制characterization听诊要点clinicalmeaning临床意义Mechanisms杂音产生机制turbulentflow→vortices→murmur湍流→旋涡→杂音Enhancedbloodflowvelocity血流加速Stenosisofvalves瓣膜狭窄(器质性相对性)Insufficiencyofvalves关闭不全(器质性相对性)Abnormalpathway(shunt)异常

2、通道(分流)Floatingmaterialsincirculation心腔漂流物或异常结构Stenosisordilationofbloodvessels血管腔扩大或狭窄Duration杂音时期Systolicmurmur(SM)HolosystolicEarlyMidsystolicLateDiastolicmurmur(DM)HolodiastolicEarlyMiddiastolicLate(presystolic)Continuous收缩期杂音全收缩期收缩早期收缩中期收缩晚期舒张期杂音全舒张期舒张早期舒张中期舒张晚期连

3、续性杂音DistinguishDuration时期的区分systolicmurmur收缩期杂音appearbetweenS1andS2,sameasapicalimpulse在第一心音与第二心音之间出现与心尖搏动一致diastolicmurmur舒张期杂音appearbetweenS2andS1,nonsameasapicalimpulse在第二心音与第一心音之间出现与心尖搏动不一致BothPhaseandContinuesMurmur双期杂音与连续性杂音Bothphasemurmur双期杂音Cause:mitralstenos

4、isandinsufficiency疾病:二狭二闭Heartmurmurappearsinsystoleanddiastolerespectively.收缩舒张期分别出现杂音Auscultation:QualitydifferentandS2still特点:杂音性质可不同不遮盖第二心音Continuesmurmur连续性杂音Cause:Patentductusarteriosus疾病:动脉导管未闭Startsinsystole,continueswithoutinterruptionthroughS2intodiastole.跨

5、越收缩期和舒张期Auscultation:QualitysameandS2disappear.特点:杂音性质相同遮盖第二心音PitchandQuality杂音性质Coarseormaidlike粗糙、柔和Blowing吹风样Rumbling隆隆样signingsound叹气样(泼水样)Machine-likevibratory机器样Musical乐音样(鸟鸣样鸥鸣鸽鸣雁鸣)Intensity杂音强度Influencingfactors:影响因素Degreeofchangebetweencalibersofthepassagest

6、hroughwhichthebloodisflowing通道口的大小Degreeofpressuredifferentialbetweenthepassages通道两端的压力差Speedofthebloodflow血流速度Thicknessofthetissuesbetweentheheartandthesurfaceofthechest传导距离IntensityofSystolicMurmur收缩期杂音强度GradeⅠ:barelyaudibleinquietroom1级:仔细听方可听到GradeⅡ:quietbutclear

7、lyaudible2级:容易听到但不响亮GradeⅢ:moderatelyloud3级:较响亮GradeⅣ:loud,associatedwiththrill4级:粗糙且响亮伴传导震颤GradeⅤ:veryloud,thrilleasilypalpable5级:震耳GradeⅥ:veryloud,audiblewithstethoscopenotincontactwithchest,thrillpalpableandvisible6级:离开胸壁亦可闻及ConfigurationorShape杂音形态Typesofintensit

8、yvariety杂音强度变化类型Crescendo:increasingintensity递增型:强度逐渐增加Decrescendo:decreasingintensity递减型:强度逐渐减小Crescendo-decrescendo:递增递减型:强度先增加后减