Ngokubhuduzela apical. Palpation wenhliziyo

Kuyini yisifiso inhliziyo? Abasebenzi bezempilo kahle ujwayelene lo mqondo. Kulabo awahlobene imisebenzi yezokwelapha, le ncazelo akunandaba kakhulu. Indlela yokwenza palpation ukukhomba indawo ngiyibona inhliziyo, kanye ezinye umehluko wemisindo nemiqondo yamagama le nqubo ngeke kube nentshisekelo wonke umuntu, kanye Ukwaziswa okwethulwa kulesi sihloko kuyoba usizo kulabo nje ufisa ukufunda izisekelo ukunakekelwa kwezempilo.

ngokubhuduzela inhliziyo

ngokubhuduzela senhliziyo - ingxenye yezwakala we anterior esifubeni odongeni, okuyinto kuvumelana Kufinyeta inhliziyo. It kungabonakala lapho libhekwa nesineke. Nakuba kwezinye izimo, ngiyibona apical abakwazi ukubona:

• ukukhuluphala;
• ewumngcingo intercostal izikhala;
• imisipha athuthukile;
• Amabele ezinkulu.

Okuhle kunakho konke ukuthi kuba olubonakalayo abantu umthethosisekelo asthenic. Ukuze ukuthole, ngaphandle ukuhlolwa palpated esifundeni atrial futhi ukucacisa indawo ngiyibona inhliziyo, hlola impahla yayo ukuze uthole olunye ulwazi.

palpation amasu

Isandla sokunene endaweni kwelivi Kusolakala push, phakathi kuka-3 no-6 ku-beyizidalwa eziphakeme kunazo emaphethelweni inhliziyo. Anqume yezwakala yonkana kobuso entendeni, bese okwasekhaya ngayo ichopho umunwe index. Kufanele ukufakwa perpendicular esifubeni. Ngo okusizwa ukushaya ezivamile ukucacisa indawo sako sobunxele aphansi. Leli phuzu isayithi okusuka inhliziyo. Phela, endaweni ekhethiwe, lapho kunqunywa protrusion esifubeni uginindela esibulalayo ndlela yokuhlasela yokuhlanganisa izihlangu umunwe palpate, icala langasezantsi libe evele of it.

Uma sokudlondlobala inhliziyo ukuzizwa umfutho ngenxa yesimo kwesifuba kunzima, wenziwa nge palpation esitshekile esifubeni phambili, noma isiguli ibekwe ohlangothini lwesobunxele. Imisipha wenhliziyo lezi zikhundla uvalwe adherent esifubeni, sikhohlwe onqenqemeni yamaphaphu kwesokunxele.

Esikhathini kwesokunxele isikhundla lateral, ngiyibona inhliziyo ingezansi futhi kwesobunxele 2 cm, ngakho wagxila zenzeke isikhala intercostal, okuyinto kuchazwa ukunciphisa, kodwa ama-2 cm medial endaweni wagxila. Palpation ngiyibona apical ukuba exhale kwandisa amathuba okuthi ekutholeni indawo yayo, ngoba okwamanje nokuphakamisa diaphragm, inhliziyo, kokwenza ukunyakaza pendulum kuya kwesokunxele bese phezulu, uya evundlile, ukusunduza onqenqemeni yamaphaphu kwesokunxele.

Odokotela kunqunywa izakhiwo ezithile okusuka inhliziyo:

• indawo;
• ukumelana;
• nokudlanga;
• ukuphakama.

Indawo ngokubhuduzela inhliziyo

Ukunciphisa isihloko inhliziyo ukwakha ngiyibona inhliziyo. Phezulu is kancane medial emgqeni maphakathi no-clavicular ku 5th intercostal isikhala ngakwesokunxele. Itholakala kuqhathaniswa ngokukhululekile futhi kwenza ukuhamba pendulum-like. Uma ushintsha isikhundla umzimba, uhamba futhi ibenze kwasendaweni. Ezinye embodiments of ukuhamba push ziye achazwe ngenhla.

Lapho umuntu ngakwesokudla ohlangothini ithuba uzwakalise ukufuduka ensimini okusizwa ukushaya atrial ingekho, futhi iphaphu kwesokunxele, ngalesi sikhathi, ukukhula inhliziyo, ungakwazi ngokugcwele ihambise ogangeni esifubeni. Ngakho-ke, ngokuvamile, ngakwesokudla, okusizwa ukushaya atrial kungaba cishe zinyamalale.

ukufuduka zokucabanga okubangelwa isifo okusizwa ukushaya kwenhliziyo

I-ripple offset lahlukaniswa izinhlobo:

1. I-offset akuyona ezihlobene nesifo senhliziyo (pneumothorax, hydrothorax, iphaphu nezibazi, emphysema yamaphaphu, ezingeni okushintshiwe kokumelela diaphragm - ascites, ukukhulelwa, ukubuyisa, emaciation)
2. okusizwa ukushaya sokugembula ezihlobene nesifo senhliziyo.

Kulo mBhalo, shift kwesokunxele kwenzeka ngenxa nesanda ventricle engakwesobunxele, ngezinye izikhathi kuze anterior axillary umugqa, futhi phansi ukuze 6,7,8 intercostal izikhala. Ukwanda i-ventricle yangakwesokudla kunikeza offset kuze kube semngceleni kwesokunxele inhliziyo, kodwa push 5 intercostal isikhala.

Ukwanda okusizwa ukushaya kwenhliziyo

ziboya Square ngiyibona inhliziyo imayelana 2 cm². Uma-ke mkhulu, thina-ke khuluma ka ngokukhukhumala kwentamo noma ukusakaza ehlanzekile Jerk. Ngezinye endaweni ephansi ke lilinganiselwe.

okusizwa ukushaya Common kwenzeka uma inhliziyo kakhulu ubuso bayo eyakhelene odongeni esifubeni. It waphawula:

• nge umoya kakhulu;
• ukhulelwe;
• e izimila mediastinum nabanye.

In the ukungabikho mibandela ezichithekile ukushaqeka kungenzeka kube umphumela ukunwetshwa inhliziyo (kuzo zonke noma kunoma yiziphi izingxenye zayo).

Limited ngiyibona inhliziyo kwenzeka uma inhliziyo eyikho endaweni ezincane eyakhelene esifubeni. Isizathu salokhu kungaba:

• emphysema;
• ongaphakeme ukuma diaphragm;
• effusion pericardial ;
• Hydro, pnevmoperikard.

Ukuphakama ungacabanganga inhliziyo

Senhliziyo ukuphakama ngiyibona - amplitude wesabelo ejabhile kwesifuba. Hlukanisa okusezingeni eliphezulu, ongaphakeme futhi ejwayelekile ngiyibona inhliziyo. Ubangela ongaphakeme ziyefana for the elinganiselwe. Ngakho, izimbangela zezinkumbulo ifomu ngokukhukhumala kwentamo okusezingeni eliphezulu ngiyibona apical. Iphinde kwenzeka uma tachycardia thyrotoxicosis ngenxa, imfiva, ababhemayo, ngaphansi kwamandla aphezulu.

Resistant ngiyibona inhliziyo - okusizwa ukushaya, onikeza umuzwa awugqinsi, uzigcinele imisipha palpation, ingcindezi akulula kunika. Ngakho, uma namanje ehlasela umzimba wonke, uhlamvu oqinile ke lokhu kubizwa ngokusentshenziswa yisifiso Dome emise apical. Ngokuvamile, it is akunqunywa, kodwa Kumiswa zinokukhubazeka yomthambo i-aorta nomfutho wegazi ophezulu noma uma ethuthukisa kwesokunxele ventricular hypertrophy.

Negative ngokubhuduzela inhliziyo

Ukuhoxiswa kwesimangalo se-odongeni esifubeni endaweni okusuka inhliziyo phakathi systole - yisifiso negative apical. Ubonakala nge isandiso ecacile i-ventricle yangakwesokudla, okuyinto odlulela ithiphu posterior ka-ventricle engakwesobunxele. ukusikwa systole kungaba ukukhiqiza into enjalo.

Isihoxiso intercostal izikhala kwenzeka lapho pericarditis ingcina.

nezinye okusizwa ukushaya

Diagnostically iyehla iyenyuka Abaluleke okusizwa ukushaya le-aorta, Umthambo yamaphaphu futhi epigastrium yezwakala. Eyokuqala wabo ayibonakali evamile. Sokugembula yezwakala efanayo livela II isikhala intercostal emaphethelweni kwesokudla sternum. Izizathu ivela khona zihlanganisa:

• kwesokudla wamaphaphu nezibazi;
• ekwandiseni aorta (ugcunsula, isifo sokuvuvukala kwemithambo le-aorta unyuka, yomthambo i-aorta ne-valve ukukhubazeka).

Okusizwa ukushaya Umthambo yamaphaphu (II isikhala intercostal kuya kwesokunxele sternum) - umphumela nomfutho wegazi ophezulu yamaphaphu mitral valve zamehlo.

okusizwa ukushaya Epigastric is zitholiwe fossa epigastric. Izizathu ivela khona:

• ptosis ka-ventricle yangakwesokudla;
• besisu useshonile yomthambo i-aorta.

isiphetho

Izindlela ngenhla echazwe zocwaningo Kubalulekile odokotela, kodwa ngokuqondene ukuthuthukiswa hardware ukuhlola, odokotela nokuzinikela ngokuchaza zokugula by wokuhlola ezibukwayo futhi palpation saleli shumi lokugcina leminyaka yehlile kakhulu.

Ngesikhathi esifanayo, isidingo uqhubeke lo mkhuba ngenhla kuphezulu kakhulu. Ochwepheshe ukunquma ngiyibona apical ngu palpation, kufanele bakhuthazwe futhi ngenkuthalo basakaza ukwaziswa okwengeziwe mayelana nesicelo le ndlela kwezokwelapha.

Ezimweni eziningi, ukusetshenziswa palpation kwaholela imiphumela emihle, kuhlanganise ekuhlonzweni lesi sifo. Kukhethwe onekhono ngiyibona apical (e pathologies evamile futhi ahlukahlukene) liyipharamitha abalulekile sokusungula izindlela ukwelapha iziguli.