常見呼吸系統(tǒng)疾病癥狀體征

1、常見呼吸系統(tǒng)疾病癥狀體征常見呼吸系統(tǒng)疾病癥狀體征一、以大葉分布的肺臟炎性病變，病理改變分為三期，充血期、實變期、消散期。Lobrpneumoniisdefinedsninfectionoflungprenchymwithlobrdistributionofconsolidtion.Itspthologiclchngescouldbedividedintothreestges,whichincludecongestion,consolidtionndresolution.癥狀SymptomsXX壯年，誘因，起病急Youngdultswithmotivtion,suddenonset.寒顫、高熱、

2、胸痛、咳嗽、鐵銹色痰Chills,highfever,chestpin,cough,rustysputum.體征signs急性熱病容，呼吸困難，口唇皰疹。Fceofcuteillndfever,dyspne,herpeslbilis視診：呼吸動度減弱Inspection:decreseofrespirtorymovement觸診：語音振顫增強，氣管居中Plption:increseofvoclfremitus,trcheinmiddleposition扣診：濁音Percussion:dullness聽診：管狀呼吸音，胸膜摩擦音，濕羅音usculttion:bronchilbrethsound,

3、pleurlfrictionrub,rles.二、慢性堵塞性肺病(chronicobstructivepulmonrydiseseCOPD)慢性堵塞性肺病是一種具有氣流受限特征的肺部疾病，氣流受限不完全可逆，呈進行性進展。確切的病因還不十分清楚，但認(rèn)為與肺部對有害氣體或有害顆粒的異常炎癥反應(yīng)有關(guān)。COPDhsbeendefinedsdisesechrcterizedbythepresenceofirflowlimittion,whichisprtillyreversiblendgenerllyprogressive.TheexctcuseofCOPDstillreminsuncler,butm

4、ostlyisssocitedwithbnormllypulmonryinflmmtoryresponsetothehrmfulgsesorprticles.癥狀：Symptoms慢性咳嗽，咳痰，白色粘液泡沫痰，合并感染時可為膿性,冬季加劇.Chronicproductivecough,whitishmucoidfrothysputum,yellowishsputumwhencomplictedwithinfection.ggrvtioninthewinter,氣短或呼吸困難,喘息shortofbrethordyspne,wheezing,dyspnewithexertion.體征：signs

5、1. 視診:胸廓呈桶狀，肋間隙增寬，呼吸動度減弱Inspection:brrelchest,decreseofrespirtorymovement2. 觸診：語顫減弱Plption:decreseofvoclfremitus.3. 叩診：雙肺叩診呈過清音，肺下界下降，心界縮小，肝濁音界下移Percussion:bilterlhyperresonnce4. 聽診：肺泡呼吸音減弱，散在干濕羅音usculttion:decreseofbrethsoundsnddiffusedrhonchindrles三、支氣管哮喘（bronchilsthm）是由多種細(xì)胞（如嗜酸性粒細(xì)胞，肥大細(xì)胞，T細(xì)胞，中性粒細(xì)胞

6、，氣道上皮細(xì)胞等）和細(xì)胞組分參與的氣道慢性炎癥性疾病。這種慢性炎癥導(dǎo)致氣道反應(yīng)性增加，通常出現(xiàn)廣泛多變的可逆性氣流受限，并引起反復(fù)發(fā)作性的喘息，氣急，胸悶或咳嗽等癥狀，常在夜間和（或）清晨發(fā)作，加劇，多數(shù)患者可自行緩解Bronchil sthm is或經(jīng)治療緩解。chronicinflmmtorydisorderoftheirwyinwhichmnycellsndcellulrcomponentsplyrole,inprticulrmstcells,eosinophils,T-lymphocytes,neutrophils,epithelilcellsndsoforth.Thischronic

7、inflmmtioncusesirwyhyperresponsivenessndrecurrentepisodesofwheezing,brethlessness,chesttightness,ndcough,prticulrlytnightnd/orintheerlymorning.Thesesymptomsreusullyssocitedwithwidespredbutvribleirwylimittionthtisreversibleeitherspontneouslyorwithtretment.癥狀Symptoms1. 幼年或XX年期發(fā)病，反復(fù)發(fā)作，季節(jié)性。Childhoodordo

8、lescenceonset,recurrentttcksndsesonlity.2. 過敏原接觸史，過敏性鼻炎癥狀Contctofllergen,llergicrhinitis3. 胸悶，帶有哮鳴音的呼氣性呼吸困難Chesttightness,expirtorydyspnewithwheezing4. 癥狀可經(jīng)治療緩解或自行緩解Remissionspontneouslyorwithtretment.體征Signs1. 視診：呼氣性呼吸困難，被迫端坐位，輔助呼吸肌參與呼吸，大汗，紫絹，胸廓飽滿，呈吸氣位。Inspection:expirtorydyspne,forcedsittingpositi

9、on,ccessoryrespirtorymuscleuse,sweting,cynosis,chesthyperinfltion.2. 觸診：呼吸動度變小，語顫減弱Plption:decreseofrespirtorymovementndfremitus.3. 叩診：過清音Percussion:hyperresonntnote4. 聽診：兩肺滿布干羅音usculttion:diffusedrhonchi.四、胸腔積液(pleurleffusion)胸膜毛細(xì)血管內(nèi)靜水壓增高，膠體滲透壓降低或胸膜毛細(xì)血管通透性增加所致胸膜液體產(chǎn)生增多或汲取減少，使胸膜腔內(nèi)積聚的液體較正常為多。胸腔積液的性質(zhì)可分

10、為滲出液和漏出液。Pleurleffusionisdefinedsthebnormlccumultionoffluidwithinthepleurlspce.Itmybecusedbyneitherexcessfluidproductionordecresedbsorption,whichressocitedwithincresedpleurlcpillrieshydrostticpressureordecresedoncoticpressureorincresedpleurlcpillriespermebility.Thechrcterofpleurlfluidcnbedividedinto

11、exudtesndtrnsudte.癥狀：Symptoms1. v300ml癥狀不明顯Thesymptomsrenotobviouswhenthefluidislessthn300ml2. 干咳，胸痛。胸液增多時胸痛減輕Drycough,pleuriticchestpin,thepinwillbepllitedwhenthefluidincrese3. >500ml氣短、胸悶shortbrethndchesttightnesswhenthefluidisover500ml4. 大量胸腔積液呼吸困難、發(fā)組dyspnendcynosiswhenthefluidislrge.5. 基礎(chǔ)疾病癥狀

12、symptomsofthebsicdisese.體征Signs1 .少量胸液常無體征Usullythereisnosignsifthefluidis<500ml2 .中至大量積液Middletolrgefluid視診：呼吸受限，肋間飽滿Inspection:restrictionoftherespirtorymovementontheffectedside,bulgingintercostlsmrgins觸診：心尖搏動及氣管移向健側(cè)，語顫減弱Plption:shiftofpexbetndtrchetotheuninvolvedside.bsenttctilefremitusovereff

13、usion叩診：積液區(qū)濁音或?qū)嵰鬚ercussion:dullnessontheeffusionre.聽診：積液區(qū)呼吸音減弱或消逝，積液區(qū)上方可聽到支氣管呼吸音，纖維索性胸膜炎可聽到胸膜摩擦音usculttion：Decresedorbsentbrethsoundsovertheeffusion.Bronchilbrethsoundscouldbeherdbovethepleurleffusion.pleurlrubcouldbeherdindryorfibrinouspleurisy五、氣胸(pneumothorx)空氣進入胸腔.irinthepleurlspce根據(jù)病因可分為；Cnbecl

14、ssifiedsfollowsccordingtothecustivefctors1. 自發(fā)性氣胸：堵塞性肺氣腫、肺結(jié)核等spontneouspneumothorx:COPD,pulmonrytuberculosis.2. 人工氣胸：rtificilpneumothorx3. 外傷性氣胸：trumticpneumothorx根據(jù)胸膜破裂的情況，臨床分為；clssifiedclinicllysfollowsccordingtothepleurlhole1. 閉合性closedpneumothorx2. 交通性openpneumothorx3. 張力性tensionpneumothorx.癥狀Sy

15、mptoms1. 誘因：motivtion(strenuousexertion)2. 突發(fā)一側(cè)胸痛伴呼吸困難suddenonsetwithunilterlpleuriticpinnddyspne.Thedegreeofdyspnevriesccordingtothesizeofthepneumothorxndthelungshelthycondition3. 患者基礎(chǔ)肺功能好，小量閉合性氣胸，僅有輕度氣急，數(shù)小時后可逐漸平穩(wěn)smllclosedpneumothorxwithgoodbsiclungfunction,theinitildyspneisslightndwillimprovefter

16、fewhours.4. 大量張力性氣胸嚴(yán)峻呼吸困難，同時可有呼吸循環(huán)衰竭的表現(xiàn)lrgetensionpneumothorxwillproduceseverdyspnendevenrespirtoryorcircultoryfilure體征Signs1 .少量胸腔積氣常無明顯體征noobvioussignsifpneumothorxissmll2 .大量積氣lrgepneumothorx視診：患側(cè)胸廓飽滿，肋間隙變寬，呼吸動度減弱Inspection:theffectedthorcicisfullndtherespirtorymovementisrestricted.觸診：氣管、心臟移向健側(cè)，語

17、顫減弱或消逝Plption:trchelndpexbetdevition,voclfremitusdiminishedordisppered.叩診：患側(cè)呈鼓音.Percussion:hyper-resonnceonpercussion聽診：患側(cè)呼吸音減弱或消逝usculttion:diminutionofbrethsounds.肺不張(telectsis)肺泡容積減少lossoflveolrvolume1. 堵塞性肺不張obstructivetelectsis異物、腫瘤、痰拴、支氣管內(nèi)膜結(jié)核等foreignbody,neoplsm,sputumplug,endobronchiltubercul

18、osis2. 非堵塞性肺不張non-obstructivetelectsis壓縮性（氣胸、積液）compressive,e.g.pneumothorx,pleurleffusion癥狀Symptoms:與肺不張的范圍、程度相關(guān)vriesccordingtotheextentnddegreeoftelectsis.呼吸困難、咳嗽，繼發(fā)感染時有相應(yīng)的中毒癥狀dyspne,cough,toxicsymptomssocitedwithsecondryinfection.體征Signs:視診：患側(cè)胸廓塌陷，呼吸動度減弱Inspection:retrctionoftheinvolvedsidendtherespirtorymovementisrestricted.觸診：心臟、氣管移向患側(cè)，語顫減弱，壓縮性肺不張語顫可增強Plpti