体格检查体格检查12ForewordForeword 前言前言DonDon t touch the patientt touch the patient state first what you see;state first what you see; cultivate your powers ofcultivate your powers of observation.observation. SIR WILLIAM OSLERSIR WILLIAM OSLER1849-1919 1849-19193Take home messageThe medical history and physical examination The medical history and physical examination is the most valuable part of the clinical is the most valuable part of the clinical examination in reaching a diagnosis.examination in reaching a diagnosis.4Pay Attention to the FollowingsPay Attention to the Followings 体格检查注意事项体格检查注意事项n nIntroductionIntroductionn nYour behaviorYour behaviorn nSurroundingsSurroundingsn nPrivacyPrivacyn nPositionPositionn nSequenceSequencen n介绍介绍n n行为举止恰当行为举止恰当n n环境合适环境合适n n注意病人的隐私权注意病人的隐私权n n体检时病人的体位体检时病人的体位n n体检的顺序体检的顺序查体顺序n n卧位患者：一般情况和生命体征卧位患者：一般情况和生命体征头颈部头颈部前、侧前、侧 胸部（心、肺）患者取坐位后背部（包括肺、脊柱胸部（心、肺）患者取坐位后背部（包括肺、脊柱 、肾区、骶部）卧位腹部、肾区、骶部）卧位腹部上、下肢上、下肢肛门直肠肛门直肠 外生殖器外生殖器神经系统（最后站立位）。神经系统（最后站立位）。n n坐位患者：一般情况和生命体征坐位患者：一般情况和生命体征上肢上肢头颈部头颈部 后背部（包括肺、脊柱、肾区、骶部）患者取卧位后背部（包括肺、脊柱、肾区、骶部）患者取卧位 前、侧胸部（心、肺）前、侧胸部（心、肺）腹部腹部下肢下肢肛门直肠肛门直肠 外生殖器外生殖器神经系统（最后站立位）。神经系统（最后站立位）。56第一章第一章 基本检查方法基本检查方法 Basic Examination TechniquesBasic Examination Techniquesn n视诊视诊 inspectioninspectionn n触诊触诊 palpationpalpationn n叩诊叩诊 percussionpercussionn n听诊听诊 auscultationauscultationn n嗅诊嗅诊 olfactory examinationolfactory examination7Tools of the Physical ExamnStethoscopenBP cuffnOtoscopenOphthalmoscopenCan you think of any other tools?第一章 基本检查方法8InspectionInspection视诊视诊: : the first the first step in physical examinationstep in physical examinationn nThe areas to be inspected should be visibleThe areas to be inspected should be visible充分暴露所视部位充分暴露所视部位n nGood lighting is importantGood lighting is important光照良好光照良好 n nThe angle of the light can be used to The angle of the light can be used to advantageadvantage角度合适角度合适n nInspection and thinking with knowledgeInspection and thinking with knowledge边视诊边思考边视诊边思考第一章 基本检查方法9PalpationPalpation 触诊触诊Light palpation Light palpation 浅部触诊法浅部触诊法 Deep palpation Deep palpation 深部触诊法深部触诊法 n nDeep slipping palpation Deep slipping palpation 滑行触诊法滑行触诊法 n nBimanual palpation Bimanual palpation 双手触诊法双手触诊法 n nDeep press palpation Deep press palpation 深压触诊法深压触诊法 n nBallottement Ballottement 冲击触诊法冲击触诊法 第一章 基本检查方法10Light PalpationLight Palpation 浅部触诊手法浅部触诊手法第一章 基本检查方法11Deep PalpationDeep Palpation 深部触诊手法深部触诊手法第一章 基本检查方法12Bimanual PalpationBimanual Palpation 双手触诊手法双手触诊手法第一章 基本检查方法触诊注意事项1.1.手法轻柔手法轻柔2.2.从无病部位到有病部位从无病部位到有病部位3.3.观察病人表情观察病人表情4.4.边检查边思考边检查边思考13第一章 基本检查方法14PercussionPercussion 叩诊叩诊direct percussion indirect percussiondirect percussion indirect percussion 直接叩诊直接叩诊 间接叩诊间接叩诊 第一章 基本检查方法15Indirect PercussionIndirect Percussion 间接叩诊间接叩诊n nTapping the Tapping the interphalangealinterphalangeal joint. joint.n nOnly the middle finger of the Only the middle finger of the nondominantnondominant hand should be in hand should be in contact with the skin surface.contact with the skin surface.n nTapping quickly.Tapping quickly.n n叩击左手中指叩击左手中指n n左手中指紧贴皮肤左手中指紧贴皮肤n n速起速落速起速落第一章 基本检查方法16Percussion NotesPercussion Notes 叩诊音叩诊音n nTympanyTympany: gas : gas n nHyperresonanceHyperresonance: increased gas : increased gas in lung tissue in lung tissue n nResonanceResonance: lung tissue: lung tissuen nDullnessDullness: gas and tissue: gas and tissuen nFlatnessFlatness: essential organ or fluid : essential organ or fluid n n鼓音鼓音: : 气体气体n n过清音过清音: : 肺组织含气增多肺组织含气增多n n清音清音: : 肺组织肺组织n n浊音浊音: : 气体与组织气体与组织n n实音实音: :实质脏器或液体实质脏器或液体第一章 基本检查方法17AuscultationAuscultation 听诊听诊Direct auscultationDirect auscultation直接听诊直接听诊Indirect auscultationIndirect auscultation间接听诊间接听诊n nBreath sounds, adventitious soundsBreath sounds, adventitious sounds肺呼吸音肺呼吸音 啰啰音音n nHeart sounds, murmursHeart sounds, murmurs心音心音 杂音杂音n nBowel sound; bowel tones; Bowel sound; bowel tones; 肠鸣音肠鸣音stethoscopestethoscope 听诊器听诊器第一章 基本检查方法听诊注意事项1.1.耳件方向：向前、向下、向内耳件方向：向前、向下、向内 2.2.胸件选择和放置：胸件选择和放置：模型胸件紧贴被检部 位皮肤，对高频声音敏感；钟型胸件轻 置于被检部位皮，对低频声音敏感 3.3.双侧对比双侧对比 4.4.全神贯注，边听诊边思考全神贯注，边听诊边思考18第一章 基本检查方法19Olfactory ExaminationOlfactory Examination 嗅诊嗅诊1.1.Fetor Fetor hepaticushepaticus in in liver diseaseliver disease2.2.Fetid breathFetid breath in lung abscess in lung abscess3.3.AmmoniacalAmmoniacal urine urine in in urinary tract infectionurinary tract infection4.4.HalitosisHalitosis in poor oral and dental hygiene in poor oral and dental hygiene5.5.Bad apple smellBad apple smell in diabetic in diabetic ketoacidosisketoacidosis6.6.Alliaceous odorAlliaceous odor in organic phosphorus intoxication in organic phosphorus intoxication1. 1.肝臭肝臭: : 肝病肝病2.2.呼出臭味呼出臭味: : 肺脓肿肺脓肿3.3.氨味氨味: : 泌尿系感染泌尿系感染4.4.口臭口臭: : 口腔感染口腔感染5.5.烂苹果味烂苹果味: : 糖尿病酮症糖尿病酮症6.6.大蒜味大蒜味: : 有机磷中毒有机磷中毒第一章 基本检查方法第二章第二章 113页一般检查一般检查20第一节第一节 全身状态检查全身状态检查Sex Sex 性别性别 Ag