肺部听诊（auscultation）

肺部听诊（auscultation） 肺部听诊(auscultation) 1. auscultation method: take the seat or lie in the examination, slightly open mouth, calm and breathe evenly. Check start from apex of lung auscultation, auscultation and order on the grounds, from the front side of the chest to the back, listen, at the same time should be around the upper and lower contrast. If necessary, ask the examiner to take a deep breath or cough several times after auscultation so as to identify the nature of the auscultation. For example, if you hear a small or asymmetrical tone, you may ask the patient to cough for a few minutes and then call the doctor, and if the rale disappears, it is suggested that it may be caused by airway secretions or accumulated factors. 2. normal breath sounds: the lungs of healthy people can hear the trachea, the sound of the trachea, the respiratory sounds of the bronchi, the breath sounds of the pulmonary alveoli and the breath sounds of the alveoli. (1) the respiratory sounds of the bronchus are very similar to the "ha" sound which is raised when the tongue is raised, and the mouth is breathing. The intensity is loud and the pitch is high. When it is inspiratory, it is weak and short, and the breath is strong and long. The ratio of inspiration and exhalation is 1:3. Normal bone in the throat cerebral fossa, sixth cervical vertebra and second thoracic vertebrae near the back can be heard, the more close to the trachea area more strong sound. (2): breath sound resembling a feel it when breathing "husband" sound, the sound of soft blowing, the tone is low; inhale sound strong, high tone, long time; exhale sound weak, low tone, time is short; inspiratory and expiratory ratio is 3:1. The majority of the normal lung population can be heard. (3) vesicular breath sounds: also called mixed breathing, a mixture of bronchial breath sounds and vesicular respiratory sounds. The intensity, tone, and time frame of the inspiratory and expiratory sounds are approximately equal. Generally speaking, The inspiratory sounds of the bronchial breath sounds are similar to those of the breath sounds of the alveolar breath, and their expiratory sounds are similar to those of the breath sounds of the bronchial breathing.. The third, fourth thoracic level and normal in the apical sternum on both sides of the first, second intercostal space, scapular region can be heard. 3. abnormal breath sounds (1) pathological alveolar breath sounds: the decrease or enhancement of pulmonary respiratory sounds caused by pathological changes of lungs or changes in their properties. The breath sound weakened or disappeared in the respiratory tract: movement disorders, respiratory obstruction, decreased lung compliance, intrathoracic tumor, pleural disease, etc.; the breath sound enhancement: in motion, hyperthyroidism, fever, anemia, metabolic acidosis and so on; the breath sounds extended: in bronchial asthma, wheezing bronchitis and chronic obstructive emphysema; local extension in egressive limitation of bronchial stenosis or partially blocked, such as lung cancer; the intermittent breathing gear: also known as breathing, in pneumonia, pulmonary tuberculosis, lung cancer, pleural adhesions; the rough breathing: in early bronchitis or pneumonia. (2) pathological bronchial breath sounds: the respiratory sounds of the bronchi are heard in the normal distribution of respiratory sounds of the alveoli, which is the pathological bronchial breathing sounds. Usually caused by the following factors: the consolidation of lung tissue: in the lobar consolidation period, pulmonary tuberculosis (large exudative lesions), also found in lung abscess, lung cancer and pulmonary infarction; the intrapulmonary cavities: in pulmonary tuberculosis, lung abscess, lung cavities etc.; Compression pulmonary atelectasis: the left scapular region and the surrounding area of the lung mass at the upper part of the median pleural effusion, massive pericardial effusion. (3) pathological pulmonary alveolar breath sounds: in the normal distribution of respiratory sounds in the alveoli, the breath sounds of the lung to the bronchi are called pathological pulmonary alveolar breathing sounds. Found in the area of pneumonia, tuberculosis, lobar pneumonia or swelling of the lungs above the pleural effusion. 4. rales: an additional sound for respiratory sounds, normal, healthy lungs, lungs are absent. (1): dry rales auscultation: inhale and exhale can be heard, but often on the exhale more clearly, because the exhale lumen more narrow; the nature of change and position changed, such as cough can increase, decrease and disappear or appear, mostly due to the secretion of the higher pitch movement; each sound, lasted for a long time; the different properties of scapus can exist at the same time; it occurs in the main bronchus than dry rales, sometimes without a stethoscope can be heard, called stridor. Scapus classification: 1: produced by rhonchus airflow through the larger bronchi or trachea viscous secretions when shaking and moving, as a rough, low tone, similar scapus sleep snoring; the sibilant: a high pitched rhonchi for air through the bronchial stenosis or spasm of the. Some like whistling or blowing flute, called the sibilant hiss; some were called sibilus. The clinical significance of dry rales: two lung sounds dry, It can be found in acute or chronic bronchitis, bronchial asthma, bronchopneumonia, cardiogenic asthma, etc.. Localized dry rale is caused by local bronchial stenosis. It is common in bronchial local tuberculosis, tumor, foreign body or sticky secretions. Localized and persistent rales are seen in early lung cancer and endobronchial tuberculosis. (2) rales (blisters): auscultation features: inhale and exhale can be heard, to end more inspiratory and clear, because the inspiratory flow faster and stronger, at the end of inspiration, bubbles easily broken; normally several blisters occurred in clusters or intermittent; part were relatively constant. Nature is not easy to change; the large, medium and small crackles can exist at the same time; the cough after rales can increase, decrease or disappear, because of cough can make the liquid mobile. Classification of bronchial rales: according to size can be divided into: coarse rales and bubbling rales, found in cavitary pulmonary tuberculosis, pulmonary edema, coma or death in patients; rales: also called in the blisters, found in bronchitis and bronchial pneumonia; the fine rales also called small blisters, found in bronchiolitis, pneumonia, pulmonary congestion and pulmonary infarction; the crepitus: also known as the twist of rales or tiny crackles, is a very fine and uniform high pitched sound, like the hand twist a bundle of hair in the ear the sound produced by. See early pneumonia, early pulmonary tuberculosis, pulmonary congestion, fibrous alveolitis, etc... The clinical significance of wet rales: moist rales are manifestations of pulmonary and bronchial lesions. Two, the lung scattered in sex distribution, common in bronchitis, bronchial pneumonia, hematogenous disseminated tuberculosis, pulmonary edema; The two distribution in the bottom of lung, pulmonary congestion, pulmonary edema and pneumonia; side or local distribution, common pneumonia, pulmonary tuberculosis (usually in the upper lung), bronchiectasis (in lower lung), lung abscess, lung cancer and pulmonary hemorrhage. 5. pleural friction sound: the pleural friction sounds like the sound of one hand covering the ear and rubbing the back of the ear with the other finger rubbing the back of the ear. Pleural friction sounds can be heard during inhalation and expiration, usually at the beginning of inhalation or expiration. When the breath is held, the pleural friction sound disappears, which can be distinguished from the pericardial friction tone. Deep breathing, or when the chest of the stethoscope pressure, pleural friction is often more clear. Pleural friction is most common in the visceral pleura and parietal pleura. The location of the pleura changes the largest part - the lower side of the chest wall, along the axillary line. Pleural friction sound: 1: if found in pleural inflammation caused by tuberculous pleurisy, purulent pleurisy and other causes of pleural inflammation: the primary or secondary pleural tumor; the pulmonary lesions involving the pleura: such as pneumonia, pulmonary infarction, pleural; the height of drying: such as severe dehydration; the other: such as uremia etc..