Auscultation - ndiko ... palpation, percussion, auscultation

Palpation, percussion, auscultation - hwomuviri kuongororwa unyanzvi hunoshandiswa navanachiremba zvose pamusoro nyika nedanho nechirwere zvirwere zvakasiyana-siyana. Nzira idzi dzinoshandiswa pachiimbwa nemakemikari uye nedzimwe mhando Analyses, richishanda kuferefeta kwezvinhu zvinoshandiswa, pane vazhinji. Zvinofadza kuti kuongorora chinangwa kunokosha inokosha basa nechirwere.

Auscultation - ndiyo nzira yakakwana uye anodzidzisa. Rinoshandiswa kuti chirwere muna vavhiyiwa, womukati mushonga, Obstetrics, Pediatrics. With nzira iyi, teererai kwemwoyo ari mudumbu, kuona kuvapo nemabayo, bronchitis, cardiac zvikanganiso uye nezvimwe zvinetso zvakawanda muvana uye vakuru.

Auscultation mwoyo vakura

Pamwe zvikuru mashoko, ndiyo zvakare nzira kuongororwa chaiko akaoma zvikuru. Anoda munhu nzeve akakwana, pfungwa mutinhimira uye kugara tsika, sezvo ane vakawanda nuances. Chirwere zvokurapa auscultation nzira yokuziva mwoyo chirwere uye zvirwere zvemapapu achiri padanho kukura.

Kuteerera mwoyo rinoitwa mune nhema kana yakamira chinzvimbo. Nokuti vamwe zvirwere, dzinoratidzwa kuchinja mwoyo yevanhu pashure muviri, saka dzimwe nguva, nokuti yakarurama nechirwere, murwere wakasuduruka mamiriro mumuviri zororo. auscultation nzira Zvinoda kuomerera zvimwe mitemo:

• nevamwe kubva ambient ruzha;
• auscultation mwoyo rinoitwa panguva mweya-akabata (kana zvichibvira), uyewo oga pamusoro inhalation uye nedzinovengwa;
• kunoda kushandisa stethoscope uye stethoscope nokuda auskultirovaniya mukuru uye vakaderera matauriro;
• kutanga kuona kuvapo uye specificity mazwi panguva dzakasiyana pfungwa, uye ipapo kuteerera vasiri kana pathological ruzha.

mwoyo percussion

Rinoshandiswa kuona miganhu muviri uye cardiac dullness. Munguva ichangopfuura, nzira iyi kunoda munhu musana chigaro. Dzimwe nyanzvi chose kusiya izvozvo, nokuti migumisiro percussion hazvina yakarurama uye vane guru chikamu subjectivity. In nzvimbo nzira iyi akauya radiography uye Ultrasound, izvo anopa mufananidzo wakakwana poukuru uye nzvimbo yemuviri.

mwoyo palpation

Zvinowanzoshandiswa nechirwere. Palpation mwoyo rinoitwa kuti zvirinani havatsananguri chinzvimbo uye simba apical chido nokutsikirira munwe kuti munharaunda rakakodzera. Mune dzimwe zvirwere dzinoratidzwa yakaisvonaka chakamira pakunodengenyeka zvine pechipfuva, kana "katsi kuti purr syndrome."

Kukwanisa kuteerera uye kunzwa

The mwoyo haanzwi mune runobva nenzira. Kune maberere ose cardiac mavharuvhu ari pachipfuva. All zvina.

1. Mitral - IV mbabvu kuruboshwe pamusoro sternum.
2. Kutsemuka - III unopinza, kuti rworudyi sternum.
3. The pulmonary vharafu - III intercostal yakasiyiwa.
4. Tricuspid - IV intercostal nzvimbo kurudyi.

Kunyange zvakadaro, pfungwa auscultation muri siyanei kubva zvakananga fungidziro, nekuti kutinhira munzvimbo idzi zvakajeka uye zvinonzwisisika.

1. Panguva chakaderedzwa mutengo mwoyo - mitral vharafu.
2. II intercostal nzvimbo kurudyi of sternum - kutsemuka.

An chiratidzo chinokosha zvirwere muungano cardiac ruzha, izvo zvinogona kugara kana kuitika pashure mumwe mutoro. Tinofanira kukwanisa kunzwa zvakanaka uye unzwe zvose yakaoma mwoyo mutinhimira. Zvakakosha kuziva kwete chete inzwi asiwo chimiro uye nzvimbo yaro inotungamirwa. Zvinogona kuitika mu systole uye diastole.

Pathological, vasiri, kana angava kwete ruzha chete, asiwo kushanda maitikiro. In nechirwere pamusoro cardiac auscultation zvinobatsira. auscultation pfungwa yakafanana ivavo pamusoro. Dai kuumba III uye IV mimwezve pasi zvinoonekera akasiyana ezvinhu (nguva chinguva, wokutanga-yechipiri chakapatsanurwa systole kana diastole).

Small mwoyo - hombe basa

Vana auscultation - iri rinokosha chaizvo chikamu nechirwere. Mwana, kunyanya diki nemhaka yezera ravo harigoni dzinoshuma nezvezvinetso zvavo. The wevana inofanira kuva chaizvo nzeve uye anokudzwa kwedzidzo, sezvo mwana wacho mwoyo pasi kushandura pamwe kukura kwayo. Anogona pakutsvaga dzichipfekeka kusaririra ruzha. Zvakakosha kuita tsanangudzo okufananidza pakati rokutanga uye rechipiri pasi kuti simba kana kusimbisa. Chero kutyora uchapupu zvinoverengeka pathological pezvakaitwa mumuviri hwomwana.

Differential chirwere chemwoyo muvana kushandisa nzira auscultation

mwoyo ruzha	kusimbisa	The yakaratidza zvokurwara (physiology)
tanga	The chakaderedzwa mutengo komoyo	The akasiya atrioventricular orifice kujekesa
chechipiri	yeropa	BP, kana vasiri tsika pakuyaruka
chechipiri	pulmonary tsinga	Patent ductus arteriosus, stenosis, insufficiency bicuspid vharafu, iri interatrial kuremara kana interventricular septum, pulmonary tsinga sclerosis, pulmofibroz, myocarditis, congestive ari pulmonary riparadzirwe
Rokutanga uye rechipiri	At pfungwa dzose	mwoyo utano pashure muviri (mumuviri kana psycho-mupfungwa)

Kuwedzera pfungwa, vanogona kukanganisa mwoyo pasi kana yavo paradzanisa. Auscultation ari chinangwa maitiro kana chiremba anoziva kuti kuteerera.

Pregnancy uye auscultation

Cardiac jira inochengeterwa uye anotanga kuramba atova vhiki pamuviri rechitatu, uye muna nhanhatu vake vakanzwa iri US. Chirwere amai uye mudumbu kunodiwa rose izwi uye kunyanya pakusununguka. The uwandu uye vanogutsikana ari dzichichinja pasi maererano fetus.

Auscultation mudumbu ndicho nyore uye inobudirira nzira kuti kusarudza chinhanho kwayo. Kuti tiite danho nyore ichi zvinoda obstetric stethoscope (aimiririra pazasi). Kana zvakakodzera, kushandisa stethoscope.

Inogona kupatsanurwa yose nguva pamuviri anoverengeka nguva (nokuti kuipa fetus kwemwoyo, uyewo hunhu kuzara kwavo).

Zvinofadza kuti pane 6 vhiki pashure pamuviri, mwoyo mwero mwana rinobatana mubereki. The musiyano angava mbambo 3 zvichikwira kana pasi. Uyezve reductions kwenhamba rinotanga kukura. Sezvo mwoyo mwero kunowedzera rimwe zuva 3 kurira kwepfuti, zviri bvumidzwa kuona makore azvarwa histologically.

Mwoyo pashure pemwedzi miviri pamuviri yakakamurwa partitions kupinda makamuri mana - the atria uye ventricles. mamiriro Izvi ane muviri mukuru. Pakutanga wa9 vhiki fetus mwoyo anoita anenge 175 anorova paminiti. Next, kakawanda zvinoderedza kubva wechipiri trimester, zvakajairika mudumbu anova 140-160 pakati zvibhakera. Chero yakatsauka kubva pairi inoratidza hypoxia uye tachycardia inechirevo kutanga mwero okisijeni kushaikwa, uye bradycardia - rinorema danho, rinoda pakarepo kupindira.

fetus palpation

Palpable yechipiri yezana pamuviri anogona kuona nzvimbo mudumbu wayo nomumwe mitezo dumbu. Uyezve, akaronga gestational makore mai panguva kukwirira yakamira pasi, uyewo hwomwana musoro kana zvakasimba aimanikidzwa wokupinda mumudziyo wokugezera duku - Ndivo harbingers kuberekwa rokutanga. In Obstetrics Leopold akashandisa nzira iyo ine matanho mana makuru.

Auscultation uye kusununguka

Rinyerere kwemwoyo angava kuratidzwa zvokurwara uye chepuraimari kuoma kunzwa. Izvi zvinoitika kana rwaamai abdominal rusvingo thickening (kufutisa), fetus zvakaipa nzvimbo (semuenzaniso, a rwemberi maonero occipital kana breech) polyhydramnios uye t. D. Kazhinji muted pasi kwemwoyo kunoitika nenzira Generic munguva. Chirwere fetus muviri panguva ino hwatakazvarwa.

Mumwe nzira kuongorora mukadzi pamuviri - palpation. Zvinobatsira kuziva nzvimbo mudumbu uye mharidzo yacho. Asi chete mugumisiro anogona kubudirira kana kuti chirwere fetus kuvandudzika mwoyo auscultation kushandiswa. auscultation akajekerwa noruzhinji. Kana mwoyo richinzi zvakanyatsojeka pamusoro mai guvhu, fetus ndiye breech mharidzo, kana zviri pazasi - musoro. Mwana anogona kuva hyperactive, akatendeuka "rumwe," nguva yose pamuviri. Kuteerera yakajeka inzwi pachiyero kweguvhu zvinoratidza transverse chinzvimbo.

Auscultation iri nechirwere zvirwere zvemapapu

Auscultation - ndiyo nzira kutamba inokosha pakuita chirwere muna zvirwere zvemapapu. Kusiyanisa zvakarurama (kana vesicular) uye dzakasiyana siyana chinofema abnormalities. Uyewo, munhu anozivikanwa kuchiitwa zvakasiyana siyana zvirwere zviri akaoma kana nyoro rales vane zvimwe auscultation. Auscultation pfungwa akaronga symmetrically.

Vasiri kuchinja vesicular afemeruke

Kana munhu akanaka kana, Ukuwo, taita yakatanga kwetsandanyama, ane hypertrophied adipose zvinyama, kuchinja kufema anogona kunge yakananga kwakaderera, uye fuma yaro. Auscultation rinoshandiswa pamwe stethoscope.

Kusimbisa vesicular afemeruke maitire vana. Mumwe wake zita, iro rinogona kunzwika mune zvokurapa - puerile. Pane imwe rakasiyana chepfungwa - chete mweya pamusoro symmetric zvikamu kurudyi nekuruboshwe mativi.

Chirwere kuti bronchitis kubudikidza auscultation

Auscultation bronchitis kuitwa nenzira kwakajairika nenzira. Paunoteerera chakanangana rikwanise padariro vesicular mweya zvakaoma mhando. A kwomusikirwo kuzvimba uye aienda pamusoro Árbol sepombi. Muchirwisa colour wokufema kuomarara kwatemwa yakaoma wheezing, uye vangava yakasiyana inzwi richinjwe, uyewo kuyeuchidza vava kungotaura nezvekudzoka uye chinoridzirwa muridzo. It zvinoenderana kukura principales uye ukuru kuzara kwavo muchivande. Ivo vakanzwa zvakanaka zvose maitikiro kufema.

With kukura bronchitis, madzihwa kurimwa munzvimbo Airways kuwedzera, uye auscultation akazivisa nomutoo Inotubuka rale.

Kuteerera mapapu zvakanakisisa kana murwere amire. Zvakakodzera kuenzanisa nokufema machemero uye wheezing chete pfungwa kurudyi nekuruboshwe muviri. Pane imwe kutevedzana hwokuteerera - pfungwa auscultation - mumapapu.

Unofanira kutanga misoro uye kuzoongorora pamberi pamusoro, uye ipapo parutivi uye neshure. In kuramba tichishanda bronchitis angabatana yokuwedzera ruzha Somuenzaniso, crepitus, izvo zvinoratidza inonzi yakapedza kuzvimba panzvimbo dzapasi Airways.

Auscultation of mapapu rinoitwa mumatanho akawanda; panguva dzose kudzika uye mweya mushure vangakosora. Kunyanya zvizere kuongorora pfungwa auscultation, inova yakawanda "kufungira" nokuti chiremba.

Chirwere echirwere bronchitis zvakare kuvakwa pamusoro auscultation Data uye rabhoritari zvidzidzo zviri zvipenyu zvinhu. Paunoteerera zvemapapu vesicular kufema mhando kutsunga pamberi refu vanachandagwinyira kana nedzinovengwa sezvo iri rikwanise danho. Dzimwe nguva, chisingaperi bronchitis chinokurwadzai kukura chirwere zvikuru - emphysema. "Cotton" Mune iyi, zvinova mweya. Munguva chenjera wheezing vari vakanzwa yose zvemapapu pamusoro.

percussion chiedza

Percussion Ongororo anogona kuitwa munzira nhatu: ne zvakananga tapping ari kuongorora nzvimbo kuburikidza ndiro kana chigunwe pamusoro nomunwe. Pari kupfuura zvinoshanda okupedzisira. Nzira iyi haatarisiri okuwedzera midziyo panguva chiremba, uye vari kuongorora mumapapu zviri zvikuru anodzidzisa.

Percussion vangave okufananidza kana topographical nemunhu. The inonyanya kufarirwa musimboti wokutanga, rinoshandiswa kuitira kuziva maronda. Ivo chisimbiso, saka percussion kurira pamusoro pawo mamwe yakagomara kupfuura utano zvemapapu tishu.

Kune rinoreva zvakawanda uye pasi zvikaramba kana kuongorora ruzha. Kazhinji, unofanira kuva guru, shrill uye kwenguva yakareba. Kana paiva dullness, dullness kuti matauriro, esimbi Hue, boxed kana thympanitis - inoratidza kuvapo murwere, kana zvimwe anogumbura pezvakaitwa mumapapu, rinoda kurapwa kupindira.

Auscultation iri nechirwere kwezvirwere of zvomudumbu turakiti

Kuterera rinoshandiswa sezvo nzira nechirwere vanoverengeka zvirwere nemudumbu. Imwe ongororo yakaitwa chiremba uchishandisa stethoscope, kana kuisa nzeve yake kuti abdominal madziro. Kuburikidza nzira iyi yakatsunga nokuvapo (kusavapo) kuti peristalsis ari ura kana mudumbu.

Auscultation rinoitwa pasi okufananidza nheyo, riri kuwana yakakwana mufananidzo hwokuteerera kunodiwa panguva zvakawanda. Unofanira kuitisa kuongorora wakanyarara uye, kana zvichiita, pasina kushanda chero kumanikidza mudumbu.

palpation of mudumbu

Kuongorora mudumbu anotakura vaifanira informativeness palpation nzira. It rinoitwa kumanikidza zvinyoronyoro pamusoro mudumbu. Tinofanira kutanga kuruboshwe groin inodziya maoko, kuti arege kukonzera kusagadzikana kumurwere. Izvi zvinokosha kuti asava dzepanguva abdominal rusvingo makakatanwa.

Inspection uchipfuura okufananidza kuongorora kurudyi uye rworuboshwe pasi kumusoro hafu. Pressure pamusoro epigastric dunhu - wokupedzisira. With soreness ichi akatsunga siyana nhengo iri abdominal rusvingo makakatanwa, kuvapo Urume mudumbu (kusiyana-siyana chirwere).

abdominal percussion

percussion nzira yokuziva miganhu chiropa uye chirwatata, sezvo ivo vari zvachose patainzwa kurira (hudyu). Mukuwedzera, achienzanisa gastric uye intestinal thympanitis, chiremba anogona kuita chirwere pakati mhingaidzo vamwe madhipatimendi.

Mhedziso chiropa dullness anowanzoitwa kurondedzerwa kurutivi zvakarurama IV intercostal nzvimbo tichitarisa avhareji munyatso mutsetse. Kana munguva pakuongorora nzvimbo iyi tympanic inzwi iri dzakaonekwa, ichi chinoratidza perforation zvomukati, kureva muna mhango pane mvura.

Percussing chirwatata hakuna anoshanda kukosha: Musana pamupendero poschupyvaetsya nyore palpable.