常见呼吸系统疾病症状体征.docx

1、常见呼吸系统疾病症状体征常见呼吸系统疾病症状体征 常见呼吸系统疾病症状体征 一、以大叶分布的肺脏炎性病变，病理改变分为三期，充血期实变期消散期。 Lobr pneumoni is defined s n infection of lung prenchym with lobr distribution of consolidtion. Its pthologicl chnges could be divided into three stges, which include congestion, consolidtion nd resolution. 症状Symptoms XX壮年，诱因，起

2、病急 Young dults with motivtion, sudden onset. 寒颤高热胸痛咳嗽铁锈色痰 Chills, high fever, chest pin, cough, rusty sputum. 体征signs 急性热病容，呼吸困难，口唇疱疹。 Fce of cute ill nd fever, dyspne, herpes lbilis 视诊：呼吸动度减弱 Inspection: decrese of respirtory movement 触诊：语音振颤增强，气管居中 Plption: increse of vocl fremitus, trche in middl

3、e position 扣诊：浊音 Percussion: dullness 听诊：管状呼吸音，胸膜摩擦音，湿罗音 usculttion: bronchil breth sound, pleurl friction rub, rles. 二慢性堵塞性肺病 (chronic obstructive pulmonry disese COPD) 慢性堵塞性肺病是一种具有气流受限特征的肺部疾病，气流受限不完全可逆，呈进行性进展。确切的病因还不十分清楚，但认为与肺部对有害气体或有害颗粒的异常炎症反应有关。COPD hs been defined s disese chrcterized by the pr

4、esence of irflow limittion, which is prtilly reversible nd generlly progressive. The exct cuse of COPD still remins uncler, but mostly is ssocited with bnormlly pulmonry inflmmtory response to the hrmful gses or prticles. 症状：Symptoms 慢性咳嗽，咳痰，白色粘液泡沫痰，合并感染时可为脓性, 冬季加剧. Chronic productive cough, whitish

5、 mucoid frothy sputum, yellowish sputum when complicted with infection. ggrvtion in the winter, 气短或呼吸困难, 喘息 short of breth or dyspne, wheezing, dyspne with exertion. 体征：signs 1.视诊: 胸廓呈桶状，肋间隙增宽，呼吸动度减弱 Inspection: brrel chest, decrese of respirtory movement 2.触诊：语颤减弱 Plption: decrese of vocl fremitus.

6、 3.叩诊：双肺叩诊呈过清音，肺下界下降，心界缩小，肝浊音界下移 Percussion: bilterl hyperresonnce 4.听诊：肺泡呼吸音减弱，散在干湿罗音 usculttion: decrese of breth sounds nd diffused rhonchi nd rles 三、支气管哮喘(bronchil sthm) 是由多种细胞（如嗜酸性粒细胞，肥大细胞，T细胞，中性粒细胞，气道上皮细胞等）和细胞组分参与的气道慢性炎症性疾病。这种慢性炎症导致气道反应性增加，通常出现广泛多变的可逆性气流受限，并引起反复发作性的喘息，气急，胸闷或咳嗽等症状，常在夜间和（或）清晨发作，

7、加剧，多数患者可自行缓解或经治疗缓解。 Bronchil sthm is chronic inflmmtory disorder of the irwy in which mny cells nd cellulr components ply role, in prticulr mst cells, eosinophils, T-lymphocytes, neutrophils, epithelil cells nd so forth. This chronic inflmmtion cuses irwy hyperresponsiveness nd recurrent episodes of

8、 wheezing, brethlessness, chest tightness, nd cough, prticulrly t night nd/or in the erly morning. These symptoms re usully ssocited with widespred but vrible irwy limittion tht is reversible either spontneously or with tretment. 症状Symptoms 1.幼年或XX年期发病，反复发作，季节性。 Childhood or dolescence onset, recurr

9、ent ttcks nd sesonlity. 2.过敏原接触史，过敏性鼻炎症状 Contct of llergen, llergic rhinitis 3.胸闷，带有哮鸣音的呼气性呼吸困难 Chest tightness, expirtory dyspne with wheezing 4.症状可经治疗缓解或自行缓解 Remission spontneously or with tretment. 体征Signs 1.视诊：呼气性呼吸困难，被迫端坐位，辅助呼吸肌参与呼吸，大汗，紫绀，胸廓饱 满，呈吸气位。 Inspection: expirtory dyspne, forced sitting

10、 position, ccessory respirtory muscle use, sweting, cynosis, chest hyperinfltion. 2.触诊：呼吸动度变小，语颤减弱 Plption: decrese of respirtory movement nd fremitus. 3.叩诊：过清音 Percussion: hyperresonnt note 4. 听诊：两肺满布干罗音 usculttion: diffused rhonchi. 四、胸腔积液(pleurl effusion) 胸膜毛细血管内静水压增高，胶体渗透压降低或胸膜毛细血管通透性增加所致胸膜液体产生增

11、多或汲取减少，使胸膜腔内积聚的液体较正常为多。 胸腔积液的性质可分为渗出液和漏出液。 Pleurl effusion is defined s the bnorml ccumultion of fluid within the pleurl spce. It my be cused by n either excess fluid production or decresed bsorption, which re ssocited with incresed pleurl cpillries hydrosttic pressure or decresed oncotic pressure o

12、r incresed pleurl cpillries permebility. The chrcter of pleurl fluid cn be divided into exudtes nd trnsudte. 症状：Symptoms 1.300ml症状不明显 The symptoms re not obvious when the fluid is less thn 300ml 2.干咳，胸痛。胸液增多时胸痛减轻 Dry cough, pleuritic chest pin, the pin will be pllited when the fluid increse 3.500ml气

13、短胸闷 short breth nd chest tightness when the fluid is over 500ml 4.大量胸腔积液呼吸困难发绀 dyspne nd cynosis when the fluid is lrge. 5.基础疾病症状 symptoms of the bsic disese. 体征Signs 1.少量胸液常无体征 Usully there is no signs if the fluid is 500ml 2.中至大量积液 Middle to lrge fluid 视诊：呼吸受限，肋间饱满 Inspection: restriction of the r

14、espirtory movement on the ffected side, bulging intercostls mrgins 触诊：心尖搏动及气管移向健侧，语颤减弱 Plption: shift of pex bet nd trche to the uninvolved side. bsent tctile fremitus over effusion 叩诊：积液区浊音或实音 Percussion: dullness on the effusion re. 听诊：积液区呼吸音减弱或消逝，积液区上方可 听到支气管呼吸音，纤维索性胸膜炎可听 到胸膜摩擦音 usculttion：Decres

15、ed or bsent breth sounds over the effusion. Bronchil breth sounds could be herd bove the pleurl effusion. pleurl rub could be herd in dry or fibrinous pleurisy 五气胸(pneumothorx) 空气进入胸腔. ir in the pleurl spce 根据病因可分为；Cn be clssified s follows ccording to the custive fctors 1.自发性气胸：堵塞性肺气肿肺结核等 spontneou

16、s pneumothorx: COPD, pulmonry tuberculosis. 2.人工气胸： rtificil pneumothorx 3.外伤性气胸： trumtic pneumothorx 根据胸膜破裂的情况，临床分为； clssified cliniclly s follows ccording to the pleurl hole 1.闭合性closed pneumothorx 2.交通性open pneumothorx 3.张力性tension pneumothorx. 症状Symptoms 1.诱因： motivtion (strenuous exertion) 2.突发

17、一侧胸痛伴呼吸困难 sudden onset with unilterl pleuritic pin nd dyspne. The degree of dyspne vries ccording to the size of the pneumothorx nd the lungs helthy condition 3.患者基础肺功能好，小量闭合性气胸，仅有轻度气急，数小时后可逐渐平稳 smll closed pneumothorx with good bsic lung function, the initil dyspne is slight nd will improve fter fe

18、w hours. 4.大量张力性气胸严峻呼吸困难，同时可有呼吸循环衰竭的表现 lrge tension pneumothorx will produce sever dyspne nd even respirtory or circultory filure 体征Signs 1.少量胸腔积气常无明显体征 no obvious signs if pneumothorx is smll 2.大量积气lrge pneumothorx 视诊：患侧胸廓饱满，肋间隙变宽，呼吸动 度减弱 Inspection: the ffected thorcic is full nd the respirtory mo

19、vement is restricted. 触诊：气管心脏移向健侧，语颤减弱或消逝 Plption: trchel nd pex bet devition, vocl fremitus diminished or disppered. 叩诊：患侧呈鼓音. Percussion: hyper-resonnce on percussion 听诊：患侧呼吸音减弱或消逝 usculttion: diminution of breth sounds. 肺不张(telectsis) 肺泡容积减少loss of lveolr volume 1. 堵塞性肺不张obstructive telectsis 异物肿

20、瘤痰拴支气管内膜结核等 foreign body, neoplsm, sputum plug, endobronchil tuberculosis 2. 非堵塞性肺不张non-obstructive telectsis 压缩性（气胸积液） compressive, e.g. pneumothorx, pleurl effusion 症状Symptoms: 与肺不张的范围程度相关 vries ccording to the extent nd degree of telectsis. 呼吸困难咳嗽，继发感染时有相应的中毒症状 dyspne, cough, toxic symptom ssocit

21、ed with secondry infection. 体征Signs: 视诊：患侧胸廓塌陷，呼吸动度减弱 Inspection: retrction of the involved side nd the respirtory movement is restricted. 触诊：心脏气管移向患侧，语颤减弱，压缩性肺不张语颤可增强 Plption: hert nd trchel shift to the ffected side, vocl fremitus is decresed, but incresed in compressed telectsis 叩诊：病肺区呈浊音 Percussion: dullness on percussion. 听诊：病肺呼吸音降低，压缩性肺不张可听到支气管肺泡呼吸音 usculttion: diminution of breth sounds on the involved side, bronchil breth sounds could be herd on the compressive telectsis. 常见四种肺与胸膜疾病体征的鉴别诊断