胸部的体表标志熟悉胸部常用体表标志,包括骨骼标志、自9.ppt

（3）叩诊：了解直接和间接叩诊法的检查方法与应用、影响叩诊音的因素。熟悉胸部叩诊音的分类，肺下界移动度的叩诊方法。掌握肺部叩诊音和肺下界移动度改变的临床意义。 （4）听诊：了解胸膜摩擦音的听诊特点和临床意义。熟悉正常呼吸音的种类、特点及分布。啰音的发生机制、分类和听诊特点，语音共振的检查法及临床意义。掌握病理性呼吸音听诊的特点和临床意义。干、湿啰音产生的临床意义。 Mention of Conduction Exposure/warmth/lighting /easy air Inspection, palpation, percussion, auscultation Anterior-lateral-posterior Top- base Comparison: top to base/ left to right Bone landmark suprasternal notch(胸骨上切迹) clavicle（锁骨） Manubrium sterni(胸骨柄) Sternal angle(胸骨角) Louis angle suprabdominal angle(腹上角) xiphoid process(剑突) Ribs interspaces scapula(肩胛骨) spinous process(棘突) costolspinal angle(肋脊角) Natural fossa anatomic region Axillary fossa Supraclavicular fossa Suprasternal fossa Infraclavicular fossa Suprascapular region Infrascapular region Interscapular region Vertical lines Anterior middle line(前正中线） Mid-clavicular lines（锁骨中线） Spinal line（后正中线） axillary lines (anterior,middle, posterior) （腋前、中、后线） Scapular lines（肩胛线） The boundary of lung pleura Lung apex Upper boundary of the lung Outer boundary Inner boundary Lower boundary: Chest wall Vein : Blood flow direction Subcutaneius emphysema(皮下气肿) Tenderness Interspace Inspection Breathing movement: Diaphragmatic vs costal respiration Respiratory rate: --- Tachypnea ---Bradypnea ---Change of the breath depths Inspection(2) Rhythm of the breath ---Tidal breathing ---Ataxic breathing ---Inhibitory breathing ---Sighing respiration Palpation Thoracic expansion Vocal fremitus(触觉语颤) Pleural friction fremitus(胸膜摩擦感) Confirm the inspection 注意事项：检查时应注意以下四点： （1）病人发音要低沉，音调不能过 高，在检查过程中发者的强度和音调要始终一致 （2）要从上到下，先前胸后背部循序进行 （3）注意左右对称部位对比检查； （4）两手贴胸．压力要轻而均等； 触诊胸膜摩擦感 (三)percussion 1.叩诊方法 direct percussion indirect percussion:the palmar surface of the left distal phalanx of the middle finger serves as the pleximeter and is firmly placed on the chest wall in an interspace;parallel to the ribs. 3.胸部叩诊音的分类 The normal percussion note varies with the thick-ness of the chest wall and the force applied by the examiner. 1 T