五首《七字诀》，分分钟搞定，视触叩听嗅！

2017-04-09 初心医学之声

一、触诊体格检查常用方法

一、触诊体格检查常用方法

分为浅部触诊和深部触诊法。触诊之前要和患者沟通，放松情绪使腹肌尽量松弛，排便排尿配合检查。

（1）浅部检查浅部病变，深度约1厘米；如：关节、软组织、皮肤、浅表动脉、静脉、淋巴结、（耳前淋巴结、耳后淋巴结、乳突区淋巴结、枕骨下淋巴结、骸骨下淋巴结、颌骨下淋巴结、颈动脉前后区和锁骨上区淋巴结、腋下、滑车淋巴结、腹股沟区和腘窝淋巴结。）神经、阴囊和精索等。触诊时注意被检查部位有无肿块、压痛、抵抗感或其他变化。

（2）深部触诊法有四种：

a.滑行触诊法：医生右手二三四指并拢平放腹壁，上下左右滑行触摸，肠管或条索状包块作与长轴垂直方向滑行触摸。一般用来检查腹腔深部脏器。

b.双手触诊法：右手置于被检查部位，左手置于被检查脏器或肿块背部，将其托向右手方向靠近体表。一般用来检查肝、脾、肾。

c.深压触诊法：一个或两个并拢手指逐渐深压腹壁被检查部位，确定压痛点和病变位置，（如：胆囊压痛点和阑尾炎压痛点）。深压片刻迅速抬起剧烈疼痛，为反跳痛。

d.冲击触诊法：右手示、中、环三指并拢，指端与腹壁呈70~90度斜角快速有力连续冲击。常用于腹水时检查腹部脏器。

触诊之前沟通好

缓解紧张松腹肌

排便排尿莫忘记

触诊因病分深浅

浅查肿块压痛点

淋巴检查特别记

耳前耳后乳突区

枕骨骸骨颌骨下

颈前颈后锁骨上

腋窝滑车腹股腘

深部触诊有四种

滑行触诊腹深器

三指并拢来回移

双手触诊肝肾脾

右手检查左托起

深压触诊两手指

探测位置与痛点

深压抬手痛加重

反跳疼痛要注意

冲击触诊靠浮沉

三手斜角置腹壁

有力连续快冲击

二、叩诊常用直接叩诊法

医生左手中指第二指节紧贴被检部位，其他手指稍微抬起；右手自然弯曲，中指指端垂直叩击左手贴被检部位手指。通过震动声响不同判断病变，清音一般正常；肺组织含气量减少如患肺炎时，则为浊音；肺实变或胸腔积液时为实音；含大量气体的空腔脏器发出鼓音；当肺组织含气量增多、弹性减弱时如慢性梗塞性肺病。

叩诊指贴莫隔衣

右中二节贴诊部

其他手指稍抬起

右手指端巧左指

清浊实鼓过轻音

声响不同判病变

清音正常气减浊

肺实胸积为实音

气多空腔似击鼓

过轻气多弹性减

三、嗅诊：

通过医生嗅觉闻患者呼吸、汗液、呕吐物、痰液、脓液、粪便和尿液的特殊气味判断病变。

嗅诊气味来判断

呼吸汗液呕吐物

痰脓粪便和尿液

四、视诊：

一般直观肉眼观察患者目前的状态和一些特殊体征通过专业知识和临床经验初步判断病变。

视诊状态和体症

知识经验很重要

五、听诊：

常用听诊器协助检查，要在安静的环境中自习听心、肺、肠蠕动的活动规律。

听诊常用听诊器

排除杂音防干扰

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2017-04-23 周周人

学习了。

0 0
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2017-04-13 tofsw

学习了谢谢分享

97 0
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Apr 11 07:26:50 CST 2017, time=2017-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=186578, encodeId=36f11865e8b3, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220814/be36b1918b4c4eeba48ae6c167571ce9/3bd4e17f256d4fdba54abc66bb0f616c.jpg, createdBy=a4042044999, createdName=jiangwei200908, createdTime=Tue Apr 11 07:19:26 CST 2017, time=2017-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=186530, encodeId=420d1865308b, content=学习了学习了再学习了！, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161006/IMG57F650B19932A3251.jpg, createdBy=fa6e1959577, createdName=1e131c8cm23(暂无匿称), createdTime=Tue Apr 11 00:16:27 CST 2017, time=2017-04-11, status=1, ipAttribution=)]
2017-04-12 tofsw

学习了谢谢分享

72 0
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2017-04-12 狼毒花1982

感谢分享学习了

69 0
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2017-04-11 为啥子

挺有趣的！

63 0
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2017-04-11 cqykthl

很好的总结。

28 0
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createdName=1e131c8cm23(暂无匿称), createdTime=Tue Apr 11 00:16:27 CST 2017, time=2017-04-11, status=1, ipAttribution=)]
2017-04-11 tofsw

学习了，非常实用

30 0
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2017-04-11 狼毒花1982

感谢分享学习了

26 0
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createdName=1e131c8cm23(暂无匿称), createdTime=Tue Apr 11 00:16:27 CST 2017, time=2017-04-11, status=1, ipAttribution=)]
2017-04-11 jiangwei200908

不错

27 0
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createdTime=Tue Apr 11 07:56:25 CST 2017, time=2017-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=186589, encodeId=ae7618658977, content=学习了，非常实用, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=74221626377, createdName=tofsw, createdTime=Tue Apr 11 07:54:24 CST 2017, time=2017-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=186581, encodeId=b7e31865819e, content=感谢分享学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuNreCBwuEU9I5ich0uE1zdHnicdKjEibG64cgLHSp5sMMFMiatLiaDaSrGOj1jAaDuTZo7vDLDhgRFHt6/0, createdBy=caa52003923, createdName=狼毒花1982, createdTime=Tue Apr 11 07:26:50 CST 2017, time=2017-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=186578, encodeId=36f11865e8b3, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220814/be36b1918b4c4eeba48ae6c167571ce9/3bd4e17f256d4fdba54abc66bb0f616c.jpg, createdBy=a4042044999, createdName=jiangwei200908, createdTime=Tue Apr 11 07:19:26 CST 2017, time=2017-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=186530, encodeId=420d1865308b, content=学习了学习了再学习了！, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161006/IMG57F650B19932A3251.jpg, createdBy=fa6e1959577, createdName=1e131c8cm23(暂无匿称), createdTime=Tue Apr 11 00:16:27 CST 2017, time=2017-04-11, status=1, ipAttribution=)]
2017-04-11 1e131c8cm23(暂无匿称)

学习了学习了再学习了！

26 0