1、呼吸系統評估呼吸系統評估Respiratory System Assessment課堂目標課堂目標Learning objectives1234說出胸部重要的體表標志說出胸部重要的體表標志To state thoracic surface marker 描述呼吸系統檢查的內容檢查描述呼吸系統檢查的內容檢查To describe the content of Respiratory System 正確進行正確進行胸壁、胸廓檢查胸壁、胸廓檢查To carry out the examination of chest wall and thoraces correctly描述并正確進行肺部檢查描述并

2、正確進行肺部檢查To describe and carry out the examination of lungs correctly檢查內容？檢查內容？Assess what?胸壁胸壁chest wall 胸廓胸廓thoraces胸膜胸膜pleura 肺臟肺臟lungs胸部體表標志胸部體表標志thoracic surface marker n骨性標志n胸骨上切跡suprasternal notchn胸骨柄manubrium of sternumn胸骨角sternal anglen劍突xiphoid processn肋間隙intercostal spracen脊柱棘突spinous prec

3、essn脊肋角costalspinal angle胸部體表標志胸部體表標志(一一)線性標志線性標志lineation of chest surface;thoracic linemarker n前正中線前正中線anterior midlinen鎖骨中線鎖骨中線midclaviucular linen腋前線腋前線anterior axillary linen腋中線腋中線midaxillary axillary linen腋后線腋后線posterior linen肩胛線肩胛線scapular linen后正中線后正中線posterior midline胸部體表標志胸部體表標志n窩區fossa /r

4、egion n腋窩axillary fossan胸骨上窩suprasternal fossan鎖骨上窩supraclavicular fossan鎖骨下窩Infraclavicular fossan肩胛上區supraclavicular regionn肩胛下區infrascapular regionn肩胛間區interscapular region（一）胸壁檢查（一）胸壁檢查the examination of chest wall n靜脈靜脈veinsn皮下氣腫皮下氣腫supcutaneous emphysema n胸壁壓痛胸壁壓痛tenderness n肋間隙肋間隙intercostal

5、sprace （二）胸廓檢查（二）胸廓檢查the examination of thoracesn正常胸廓正常胸廓normal shape of thoraces 橢圓，對稱，前后徑：左右徑為橢圓，對稱，前后徑：左右徑為1:1.51:1.5n胸廓外形改變胸廓外形改變the change of shapethe change of shape 扁平胸扁平胸 flat chest 桶狀胸桶狀胸barrel chest 佝僂病胸佝僂病胸rachitic chest 脊柱畸形脊柱畸形rachiterata 肺和胸膜檢查肺和胸膜檢查the examination of lungs and pleura

6、n視視inspection n呼吸運動呼吸運動respiratory movement 胸式呼吸胸式呼吸thoracic breathing 腹式呼吸腹式呼吸異常呼吸型態異常呼吸型態n呼吸頻率呼吸頻率n呼吸節律：呼吸節律：潮式呼吸潮式呼吸 間停呼吸間停呼吸 抑制性呼吸抑制性呼吸 嘆氣樣呼吸嘆氣樣呼吸肺和胸膜檢查n觸觸palpationn胸廓擴張度胸廓擴張度thoracic expansion n觸覺語顫觸覺語顫n胸膜摩擦感胸膜摩擦感pleural friction fremitus 肺和胸膜檢查n叩診叩診percussion A method of medical diagnosis in w

7、hich various areas of the chest are tapped to determine by resonance the condition of lungs. n叩診音叩診音清音清音resonance過清音過清音heperresonance濁音濁音dullness實音實音flatness鼓音鼓音tympany叩診叩診( (續續) )percussion-contn方法方法methodmethod 間接叩診間接叩診mediate percussion 直接叩診直接叩診immediate percussion n內容內容contentcontent 肺尖肺尖fossae 肺下界肺下界inferior boundary of lung 肺下界移動度肺下界移動度Measure diaphragmatic excursion 肺和胸膜檢查n聽聽auscultation n正常呼吸音正常呼吸音normal normal breath sound 肺泡呼吸音肺泡呼吸音 vesicular breath sound支氣管呼吸音支氣管呼吸音bronchial breath sound支氣管肺泡呼吸音支氣管肺泡呼吸音bronchovesicular bre