Apical mtima. Palpation za mtima

Kodi mongotengeka mtima? ogwira ntchito zachipatala bwino bwino mfundo imeneyi. Kwa amene si zogwirizana ndi ntchito zachipatala, tanthauzo limeneli ziribe kanthu mochuluka. Kodi kupanga palpation kudziwa malo kugunda mtima, komanso ena mokoma njirayi adzakhala chidwi kuti aliyense, ndi zomwe zili m'nkhani ino adzakhala zothandiza anthu amene chabe ofuna kuphunzira ndizosowa zaumoyo.

mtima mopupuluma

Mtima kugula - gawo ripple wa zapambuyo khoma pachifuwa, amene chikugwirizana ndi contractions mtima. Iwo Tingaone pamene kuonera wodwalayo. Ngakhale nthawi zina, apical mopupuluma simungakhoze kuziwona:

• kunenepa;
• yopapatiza malo intercostal;
• otukuka minofu;
• Chifuwa chachikulu.

Best wa onse ndi noticeable anthu ndi malamulo asthenic. Ndichipeze icho, ena kuposa kuyendera palpated matenda dera ndi kudziwa malo kugunda mtima, kupenda katundu wake kuti mumve zambiri.

njira palpation

Dzanja lamanja mu ziyerekezo ananena kankhani, pakati pa 3 ndi 6 mu mphepete pamwamba pa mtima. Kudziwa ripple kudutsa pamwamba pa kanjedza, ndiyeno localize ndi kunsonga ya index chala. Izo ziyenera kuikidwa perpendicular kwa pachifuwa. Mu pulsation ambiri kudziwa ake m'dera kumanzere ndi kutsikira. pathera malo mongotengeka mtima. Zodabwitsa ndizakuti, anasankha malo, kumene anatsimikiza protrusion pachifuwa zamkati osachiritsika phalanx palpate chala, ndipo kali ndi mbali za izo.

Ngati pamwamba mtima kuona mphamvu ndi chifukwa chikhalidwe cha chifuwa ndi zovuta, iwo anachita palpation linapendekeka patsogolo chifuwa, kapena wodwala aikidwa kumanzere. Minofu ya mtima mu malo amenewa mwamphamvu adherent m'chifuwa ndi amakankhira m'mphepete mwa m'mapapo kumanzere.

Mu anasiya malo lateral, mtima Apa ndi pansipa ndi lamanzere 2 cm, kotero cholinga kutenga malo danga intercostal, amene anafotokozedwa kuchepetsa, koma 2 cm medial m'dera adaponya. Palpation apical kugula kwa kutulutsa kumawonjezera mwayi kudziwa malo ake, chifukwa pa nthawi kutukula zakulera, mtima wofuna pendulum kayendedwe lamanzere ndipo, amapita ku malo yopingasa, akukankha m'mphepete mwa m'mapapo kumanzere.

Madokotala anatsimikiza zina zimatha mongotengeka mtima:

• malo;
• kukana;
• kuwanda;
• kutalika.

Location mtima mopupuluma

Kuchepetsa pamwamba mtima kupanga mtima mopupuluma. The pamwamba pang'ono medial mzere m'ma clavicular mu 5 intercostal danga kumanzere. Malowa ali pamtunda ndi mtima wonse, ndi kuvumbitsira pendulum ngati gulu. Ngati inu kusintha udindo wa thupi, chimachititsanso ndi kukankhira kutanthauzira. Ena embodiments la Kankhani kusamutsidwa akhala tafotokozazi.

Munthu kumanja mbali nayenso anasonyeza kusamutsidwa munda matenda pulsation zimachokeradi, ndi m'mapapo kumanzere, pa nthawi ino, patsogolo pa mtima, ingathandize kusuntha icho kwa mpanda pachifuwa. Choncho, nthawi zambiri, kumanja, matenda pulsation akhoza pafupi kutha.

Pathological kusamutsidwa kwa pulsation mtima

The ripple kuchepetsa ogaŵikana mitundu iwiri:

1. The kuchepetsa si kugwirizana ndi matenda a mtima (pneumothorax, hydrothorax, m'mapapo amamuyambitsa timabala ndiko kumayambitsa m'mapapo mwanga, adasandulika mlingo wa ataima zakulera - ascites, mimba, flatulence, emaciation)
2. Pathological pulsation kugwirizana ndi matenda a mtima.

Zikatero, chosinthira kumanzere kumachitika chifukwa cha kuchuluka kwa ventricle kumanzere, nthawi zina zapambuyo axillary mzere, kufikira 6,7,8 malo intercostal. Yowonjezera ventricle pomwe chilinso ndi kuchepetsa ku malire yatsala mtima, koma Kankhani 5 intercostal danga.

Kuchuluka kwa pulsation mtima

Square protrusions mtima Apa ndi za 2 cm². Ngati ali wamkulu, ndiye ife tikuyankhula za akakufunsani kapena kufalitsa woyera ndi kugwedezeka. Pa malo apansi ndi zochepa.

pulsation Common kumachitika pamene mtima ambiri padziko ndi pafupi ndi mpanda pachifuwa. Iwo anati:

• ndi mpweya kwambiri;
• mimba;
• mu zotupa za mediastinum ndi ena.

Popeza zinthu izi anakhetsa mantha mwina chifukwa cha kukula kwa mtima (wa onse kapena mbali zake).

Limited mtima mopupuluma kumachitika pamene mtima ndi malo ang'onoang'ono ndi pafupi pachifuwa. Chifukwa cha ichi mukhoza kukhala:

• ndiko kumayambitsa;
• otsika ubwenzi zakulera;
• pericardial effusion ;
• hydro, pnevmoperikard.

Kutalika kwa kugunda mtima

Mtima mopupuluma kutalika - matalikidwe kwa gawo kugunda a chifuwa. Kusiyanitsa mkulu, otsika ndi wabwinobwino mtima mopupuluma. Amachititsa otsika ndi mofanana zochepa. Choncho, zimayambitsa akakufunsani mawonekedwe mkulu apical mtima. Komanso kumachitika pamene tachycardia chifukwa thyrotoxicosis, malungo, osuta, pansi voteji mkulu.

Kugonjetsedwa mtima kugula - pulsation, amene amapereka kumverera kwa wandiweyani, wandiweyani minofu palpation, kuthamanga si kophweka m'manja. Choncho, ngati akadali akakufunsani, khalidwe amphamvu, ndiye limanenedwa ngati mzikiti woboola pakati apical mtima. Mwachibadwa, si mtima, koma aumbike ndi matenda oopsa kapena kupunduka kung'ambika pamene osauka kumanzere yamitsempha yamagazi hypertrophy.

Wachisoni mtima mopupuluma

Anabweza a chifuwa khoma m'dera la mongotengeka mtima pa systole - oipa apical mtima. Zikuoneka ndi kutambasuka lofotokoza za ventricle komwe amakankhira kwa zapambuyo kunsonga ya ventricle kumanzere. Systolic chidule akhoza kupanga chinthu choterocho.

Anabweza pa malo intercostal kumachitika pamene pericarditis zomatira.

pulsation ena

Diagnostically kusinthasintha kwambiri ndi pulsation kwa msempha, mtsempha wamagazi m'mapapo mwanga ndi epigastrium ripple. The oyamba ndi wosaoneka mwakale. Pathological ripple chomwecho limapezeka II intercostal danga pa nsonga lamanja la sternum lapansi. Chifukwa pakuwonekera kwake monga:

• pomwe m'mapapo amamuyambitsa timabala;
• kuwonjezera msempha (chindoko, aneurysm wa akwera msempha, kung'ambika vavu zopindika).

Pulsation m'mapapo mwanga mtsempha wamagazi (II intercostal danga kumanzere kwa sternum a) - chifukwa cha matenda oopsa m'mapapo mwanga mu zopindika mitral valavu.

Epigastric pulsation ndi wapezeka mu fossa epigastric. Chifukwa pakuwonekera kwake:

• ptosis wa ventricle bwino;
• m'mimba kung'ambika aneurysm.

Pomaliza

Pamwambapa anafotokoza njira ya kafukufuku n'kofunika kutsatilidwa, koma mogwirizana ndi chitukuko cha diagnostics hardware, madokotala kudzipereka kwa liwulo kudwala ndi kuyendera masomphenya ndi palpation wa Zaka khumi zapitazi utachepa kwambiri.

Pa nthawi yomweyo, m'pofunika kupitiriza mchitidwe pamwamba kwambiri mkulu. Akatswiri kudziwa apical Apa ndi palpation, ayenera kulimbikitsidwa ndi mwachangu popereka mauthenga kwambiri pa ntchito njira mankhwala.

Nthawi zambiri, ntchito palpation zayambitsa zabwino, kuphatikizapo matenda oyambirira a matenda. Anasankha aluso apical kugula (mu pathologies zachilendo ndipo zosiyanasiyana) ndi chizindikiro kwambiri pokhazikitsa njira odwala.