肺部听诊医疗讲义.ppt

肺部听诊医疗肺部听诊医疗肺部听诊肺部听诊 auscultation of lungs auscultation of lungs 概述：概述：概述：概述：（一）听诊方法：（一）听诊方法：（一）听诊方法：（一）听诊方法：Methods of auscultationMethods of auscultationMethods of auscultationMethods of auscultation 1.Stethoscope should be placed firmly against the chest 1.Stethoscope should be placed firmly against the chest 1.Stethoscope should be placed firmly against the chest 1.Stethoscope should be placed firmly against the chest wall.wall.wall.wall.2.The examination is usually conducted symmetrically 2.The examination is usually conducted symmetrically 2.The examination is usually conducted symmetrically 2.The examination is usually conducted symmetrically from top to bottom,and anterior to posterior of the from top to bottom,and anterior to posterior of the from top to bottom,and anterior to posterior of the from top to bottom,and anterior to posterior of the thorax.thorax.thorax.thorax.顺序：肺尖顺序：肺尖顺序：肺尖顺序：肺尖上肺上肺上肺上肺下肺，前胸下肺，前胸下肺，前胸下肺，前胸侧胸侧胸侧胸侧胸背部强调两侧对比听诊背部强调两侧对比听诊背部强调两侧对比听诊背部强调两侧对比听诊（二）听诊内容：（二）听诊内容：（二）听诊内容：（二）听诊内容：正常呼吸音正常呼吸音正常呼吸音正常呼吸音 normal breath sounds normal breath sounds normal breath sounds normal breath sounds 病理性呼吸音病理性呼吸音病理性呼吸音病理性呼吸音 abnormal breath sound abnormal breath sound abnormal breath sound abnormal breath sound 附加音附加音附加音附加音 adventitious sounds adventitious sounds adventitious sounds adventitious sounds 语音共振语音共振语音共振语音共振 vocal resonance vocal resonance vocal resonance vocal resonance 胸膜摩擦音胸膜摩擦音胸膜摩擦音胸膜摩擦音 pleural friction rub pleural friction rub pleural friction rub pleural friction rub肺部听诊方法返回返回一一.正常呼吸音正常呼吸音：（一）正常四种呼吸音：（一）正常四种呼吸音：（一）正常四种呼吸音：（一）正常四种呼吸音：气管呼吸音气管呼吸音气管呼吸音气管呼吸音 tracheal breath sound tracheal breath sound tracheal breath sound tracheal breath sound 支气管呼吸音支气管呼吸音支气管呼吸音支气管呼吸音 bronchial breath sound bronchial breath sound bronchial breath sound bronchial breath sound 支气管肺泡呼吸音支气管肺泡呼吸音支气管肺泡呼吸音支气管肺泡呼吸音 bronchovesicular sound bronchovesicular sound bronchovesicular sound bronchovesicular sound 肺泡呼吸音肺泡呼吸音肺泡呼吸音肺泡呼吸音 vesicular breath sound vesicular breath sound vesicular breath sound vesicular breath sound 鉴别要领：产生机制、分布、听诊特点。鉴别要领：产生机制、分布、听诊特点。鉴别要领：产生机制、分布、听诊特点。鉴别要领：产生机制、分布、听诊特点。1 1 肺泡呼吸音肺泡呼吸音 （vesicular breath sound)vesicular breath sound)n n产生机制：空气在细支气管和肺泡内进出移动的结果。吸气产生机制：空气在细支气管和肺泡内进出移动的结果。吸气产生机制：空气在细支气管和肺泡内进出移动的结果。吸气产生机制：空气在细支气管和肺泡内进出移动的结果。吸气时气流进入肺泡，冲击肺泡壁，使肺泡由松弛变为紧张；呼时气流进入肺泡，冲击肺泡壁，使肺泡由松弛变为紧张；呼时气流进入肺泡，冲击肺泡壁，使肺泡由松弛变为紧张；呼时气流进入肺泡，冲击肺泡壁，使肺泡由松弛变为紧张；呼气时肺泡由紧张变为松弛，这种肺泡弹性的变化和气流的振气时肺泡由紧张变为松弛，这种肺泡弹性的变化和气流的振气时肺泡由紧张变为松弛，这种肺泡弹性的变化和气流的振气时肺泡由紧张变为松弛，这种肺泡弹性的变化和气流的振动是肺泡呼吸音形成的主要因素动是肺泡呼吸音形成的主要因素动是肺泡呼吸音形成的主要因素动是肺泡呼吸音形成的主要因素n n特点：特点：特点：特点：*声音似上齿咬下唇吸气时发出的声音似上齿咬下唇吸气时发出的声音似上齿咬下唇吸气时发出的声音似上齿咬下唇吸气时发出的“fu”“fu”“fu”“fu”声声声声 *吸气相较长，呼气相较短吸气相较长，呼气相较短吸气相较长，呼气相较短吸气相较长，呼气相较短 *吸气音响比呼气强，音调高吸气音响比呼气强，音调高吸气音响比呼气强，音调高吸气音响比呼气强，音调高 n n分布：肺组织相应的体表部位分布：肺组织相应的体表部位分布：肺组织相应的体表部位分布：肺组织相应的体表部位2 2 支气管呼吸音支气管呼吸音（bronchial breath sound)bronchial breath sound)n n特点特点特点特点n n似抬舌后经口腔呼气时发出似抬舌后经口腔呼气时发出似抬舌后经口腔呼气时发出似抬舌后经口腔呼气时发出“ha”“ha”“ha”“ha”的音响的音响的音响的音响n n吸气相较呼气相短吸气相较呼气相短吸气相较呼气相短吸气相较呼气相短n n呼气音响强，音调高呼气音响强，音调高呼气音响强，音调高呼气音响强，音调高n n产生机制：吸入的空气在声门、气管或主支气管形成喘流产生机制：吸入的空气在声门、气管或主支气管形成喘流产生机制：吸入的空气在声门、气管或主支气管形成喘流产生机制：吸入的空气在声门、气管或主支气管形成喘流所产生的声音所产生的声音所产生的声音所产生的声音n n分布分布分布分布n n喉部、胸骨上窝、背部第喉部、胸骨上窝、背部第喉部、胸骨上窝、背部第喉部、胸骨上窝、背部第6 6 6 6、7 7 7 7颈椎及第颈椎及第颈椎及第颈椎及第1 1 1 1、2 2 2 2胸椎附近胸椎附近胸椎附近胸椎附近（越靠近气管区，其音响越强，音调越低）（越靠近气管区，其音响越强，音调越低）（越靠近气管区，其音响越强，音调越低）（越靠近气管区，其音响越强，音调越低）3 3 支气管肺泡呼吸音支气管肺泡呼吸音（bronchovesicular breath sound)bronchovesicular breath sound)n n产生机制：兼有支气管呼吸音和肺泡呼吸音特点的混合性呼产生机制：兼有支气管呼吸音和肺泡呼吸音特点的混合性呼产生机制：兼有支气管呼吸音和肺泡呼吸音特点的混合性呼产生机制：兼有支气管呼吸音和肺泡呼吸音特点的混合性呼吸音吸音吸音吸音n n特点特点特点特点*吸气音的性质与肺泡呼吸音相似，但音响较强，音调略高吸气音的性质与肺泡呼吸音相似，但音响较强，音调略高吸气音的性质与肺泡呼吸音相似，但音响较强，音调略高吸气音的性质与肺泡呼吸音相似，但音响较强，音调略高*呼气音的性质与支气管呼吸音相似，音响较弱，音调稍低呼气音的性质与支气管呼吸音相似，音响较弱，音调稍低呼气音的性质与支气管呼吸音相似，音响较弱，音调稍低呼气音的性质与支气管呼吸音相似，音响较弱，音调稍低*吸气相与呼气相相同吸气相与呼气相相同吸气相与呼气相相同吸气相与呼气相相同n n分布：胸骨角附近分布：胸骨角附近分布：胸骨角附近分布：胸骨角附近1 1 1 1、2 2 2 2肋间及背部肩胛间区的肋间及背部肩胛间区的肋间及背部肩胛间区的肋间及背部肩胛间区的3 3 3 3、4 4 4 4胸椎水平胸椎水平胸椎水平胸椎水平及肺尖前后部及肺尖前后部及肺尖前后部及肺尖前后部3 3种正常呼吸音特征的比较种正常呼吸音特征的比较特征特征 支气管呼吸音支气管呼吸音 支气管肺泡呼吸音支气管肺泡呼吸音 肺泡呼吸音肺泡呼吸音强度强度 响亮响亮 中等中等 柔和柔和音调音调 高高 中等中等 低低吸吸:呼呼 1:3 1:1 3:1 1:3 1:1 3:1性质性质 管样管样 沙沙声沙沙声,但管样但管样 轻柔的沙沙声轻柔的沙沙声正常听诊正常听诊区域区域 胸骨柄胸骨柄 主支气管主支气管 大部分肺野大部分肺野一一.正常呼吸音：正常呼吸音：（二）影响肺泡呼吸音强弱的因素：（二）影响肺泡呼吸音强弱的因素：（二）影响肺泡呼吸音强弱的因素：（二）影响肺泡呼吸音强弱的因素：1.1.1.1.呼吸的深浅呼吸的深浅呼吸的深浅呼吸的深浅 the depth of respiration the depth of respiration the depth of respiration the depth of respiration 2.2.2.2.肺组织弹性肺组织弹性肺组织弹性肺组织弹性 the elasticity of the lung tissue the elasticity of the lung tissue the elasticity of the lung tissue the elasticity of the lung tissue 3.3.3.3.胸壁厚度胸壁厚度胸壁厚度胸壁厚度 the thickness of the chest wall the thickness of the chest wall the thickness of the chest wall the thickness of the chest wall 4.4.4.4.年龄年龄年龄年龄:儿童老年人儿童老年人儿童老年人儿童老年人 readily audible in readily audible in readily audible in readily audible in children,and heard lightly in the aged children,and heard lightly in the aged children,and heard lightly in the aged children,and heard lightly in the aged 5.5.5.5.性别性别性别性别:男女男女男女男女 It is louder in male than in It is louder in male than in It is louder in male than in It is louder in male than in female female female female 6.6.6.6.部位：乳房下部及肩胛下部最强，其次为腋窝，肺尖部位：乳房下部及肩胛下部最强，其次为腋窝，肺尖部位：乳房下部及肩胛下部最强，其次为腋窝，肺尖部位：乳房下部及肩胛下部最强，其次为腋窝，肺尖 及肺下缘区域较弱及肺下缘区域较弱及肺下缘区域较弱及肺下缘区域较弱二二.异常呼吸音异常呼吸音1.1.1.1.异常肺泡呼吸音异常肺泡呼吸音异常肺泡呼吸音异常肺泡呼吸音：（1 1 1 1）肺泡呼吸音减弱或消失肺泡呼吸音减弱或消失肺泡呼吸音减弱或消失肺泡呼吸音减弱或消失：decrease or absence decrease or absence decrease or absence decrease or absence 1)decreased of motion of chest wall1)decreased of motion of chest wall1)decreased of motion of chest wall1)decreased of motion of chest wall 2)disorder of respiratory muscles 2)disorder of respiratory muscles 2)disorder of respiratory muscles 2)disorder of respiratory muscles 3)bronchial obstruction,3)bronchial obstruction,3)bronchial obstruction,3)bronchial obstruction,4)compression the lung,by pleural effusion 4)compression the lung,by pleural effusion 4)compression the lung,by pleural effusion 4)compression the lung,by pleural effusion 5)emphysema 5)emphysema 5)emphysema 5)emphysema (2)(2)(2)(2)肺泡呼吸音增强肺泡呼吸音增强肺泡呼吸音增强肺泡呼吸音增强 increaseincreaseincreaseincrease 1 1 1 1）bilateral increase bilateral increase bilateral increase bilateral increase 2 2 2 2）unilateral increase:compensatory mechanism of unilateral increase:compensatory mechanism of unilateral increase:compensatory mechanism of unilateral increase:compensatory mechanism of the healthy lung.the healthy lung.the healthy lung.the healthy lung.二二.异常呼吸音异常呼吸音1.1.1.1.异常肺泡呼吸音异常肺泡呼吸音异常肺泡呼吸音异常肺泡呼吸音（3 3 3 3）呼气音延长）呼气音延长）呼气音延长）呼气音延长 prolongation of expiration prolongation of expiration prolongation of expiration prolongation of expiration Narrowing of the lower respiratory tract,seen in asthma,or Narrowing of the lower respiratory tract,seen in asthma,or Narrowing of the lower respiratory tract,seen in asthma,or Narrowing of the lower respiratory tract,seen in asthma,or by loss of elasticity of the lung as in emphysema.by loss of elasticity of the lung as in emphysema.by loss of elasticity of the lung as in emphysema.by loss of elasticity of the lung as in emphysema.（4 4 4 4）断续性呼吸音）断续性呼吸音）断续性呼吸音）断续性呼吸音Cogwheel breathing soundCogwheel breathing soundCogwheel breathing soundCogwheel breathing sound（5 5 5 5）粗糙性呼吸音）粗糙性呼吸音）粗糙性呼吸音）粗糙性呼吸音二二.异常呼吸音：异常呼吸音：2.2.2.2.异常支气管呼吸音异常支气管呼吸音异常支气管呼吸音异常支气管呼吸音：tubular breath soundtubular breath soundtubular breath soundtubular breath sound the sounds are heard over the sounds are heard over the sounds are heard over the sounds are heard over the normal lung areathe normal lung areathe normal lung areathe normal lung area（1 1 1 1）肺组织实变）肺组织实变）肺组织实变）肺组织实变 consolidation of lung:consolidation of lung:consolidation of lung:consolidation of lung:(2(2(2(2）肺内大空洞）肺内大空洞）肺内大空洞）肺内大空洞 large cavity of the lunglarge cavity of the lunglarge cavity of the lunglarge cavity of the lung（3 3 3 3）压迫性肺不张）压迫性肺不张）压迫性肺不张）压迫性肺不张 Compressed atelectassisCompressed atelectassisCompressed atelectassisCompressed atelectassis 二二.异常呼吸音：异常呼吸音：3 3.异常支气管肺泡呼吸音异常支气管肺泡呼吸音 when broncho-vesicular breath sound is heard overwhen broncho-vesicular breath sound is heard over the lung field,it is abnormal,seen in ;the lung field,it is abnormal,seen in ;bronchopneumonia,bronchopneumonia,tuberculosis of lung tuberculosis of lung partial atelectasis of lung partial atelectasis of lung三三.啰音（啰音（rale）adventitious sound(一一一一)湿啰音湿啰音湿啰音湿啰音（moist ralemoist ralemoist ralemoist rale）1.1.1.1.产生机理产生机理产生机理产生机理：吸气时气体通过呼吸道内的稀薄分泌物形成水泡：吸气时气体通过呼吸道内的稀薄分泌物形成水泡：吸气时气体通过呼吸道内的稀薄分泌物形成水泡：吸气时气体通过呼吸道内的稀薄分泌物形成水泡破裂所产生的声音，或由于小支气管因分泌物粘着而闭陷，当破裂所产生的声音，或由于小支气管因分泌物粘着而闭陷，当破裂所产生的声音，或由于小支气管因分泌物粘着而闭陷，当破裂所产生的声音，或由于小支气管因分泌物粘着而闭陷，当吸气时突然张开重新充气所产生的爆裂音。吸气时突然张开重新充气所产生的爆裂音。吸气时突然张开重新充气所产生的爆裂音。吸气时突然张开重新充气所产生的爆裂音。They are produced by air-flow passing through They are produced by air-flow passing through They are produced by air-flow passing through They are produced by air-flow passing through secreation exudated in the bronchial tract,or by re-secreation exudated in the bronchial tract,or by re-secreation exudated in the bronchial tract,or by re-secreation exudated in the bronchial tract,or by re-inflation of alveoli and bronchioles,the wall of which inflation of alveoli and bronchioles,the wall of which inflation of alveoli and bronchioles,the wall of which inflation of alveoli and bronchioles,the wall of which have be come adherent as the result of moisture.have be come adherent as the result of moisture.have be come adherent as the result of moisture.have be come adherent as the result of moisture.(一一)湿啰音湿啰音（moist ralemoist rale）2.2.2.2.特点特点特点特点：*断续而短暂，一次常连续多个出现，断续而短暂，一次常连续多个出现，断续而短暂，一次常连续多个出现，断续而短暂，一次常连续多个出现，*于吸气时或吸气终末较明显，于吸气时或吸气终末较明显，于吸气时或吸气终末较明显，于吸气时或吸气终末较明显，*部位恒定，性质不易变，咳嗽后可减轻或消失部位恒定，性质不易变，咳嗽后可减轻或消失部位恒定，性质不易变，咳嗽后可减轻或消失部位恒定，性质不易变，咳嗽后可减轻或消失(一一)湿啰音湿啰音（moist ralemoist rale）3.3.3.3.分类分类分类分类：管腔径大小，渗出物多寡管腔径大小，渗出物多寡管腔径大小，渗出物多寡管腔径大小，渗出物多寡,时期：时期：时期：时期：粗湿啰粗湿啰粗湿啰粗湿啰音音音音 coarse rales:trachea,bronchi coarse rales:trachea,bronchi coarse rales:trachea,bronchi coarse rales:trachea,bronchi 中湿啰音中湿啰音中湿啰音中湿啰音 medium rales:small and medium bronchus medium rales:small and medium bronchus medium rales:small and medium bronchus medium rales:small and medium bronchus 细湿啰音细湿啰音细湿啰音细湿啰音 fine rales:alveoli,bronchioles fine rales:alveoli,bronchioles fine rales:alveoli,bronchioles fine rales:alveoli,bronchioles Velcro;Velcro;Velcro;Velcro;crepitus crepitus crepitus crepitus捻发音；捻发音；捻发音；捻发音；4.4.4.4.意义：见于支气管炎、支气管肺炎、肺泡炎、肺淤血肺水肿、支气管意义：见于支气管炎、支气管肺炎、肺泡炎、肺淤血肺水肿、支气管意义：见于支气管炎、支气管肺炎、肺泡炎、肺淤血肺水肿、支气管意义：见于支气管炎、支气管肺炎、肺泡炎、肺淤血肺水肿、支气管扩张、肺梗塞等。扩张、肺梗塞等。扩张、肺梗塞等。扩张、肺梗塞等。罗音的产生机制罗音的产生机制(二二)干啰音：干啰音：dry rales（rhonchi）1 1 1 1.产生机理产生机理产生机理产生机理：由于气管、支气管或细支气管狭窄或部分阻塞，由于气管、支气管或细支气管狭窄或部分阻塞，空气吸入或呼出时发生湍流所产生的声音空气吸入或呼出时发生湍流所产生的声音.They are produced by narrowing or partial They are produced by narrowing or partial They are produced by narrowing or partial They are produced by narrowing or partial obstruction of trachea or major bronchus by obstruction of trachea or major bronchus by obstruction of trachea or major bronchus by obstruction of trachea or major bronchus by various causes such as inflammation,congestion,various causes such as inflammation,congestion,various causes such as inflammation,congestion,various causes such as inflammation,congestion,spasm of the bronchial tree,tumor and foreign spasm of the bronchial tree,tumor and foreign spasm of the bronchial tree,tumor and foreign spasm of the bronchial tree,tumor and foreign body.body.body.body.(二二)干啰音：干啰音：dry rales（rhonchi）2.2.2.2.特点特点特点特点：音调较高，持续时间长，音调较高，持续时间长，音调较高，持续时间长，音调较高，持续时间长，呼气时明显，呼气时明显，呼气时明显，呼气时明显，部位不恒定，部位不恒定，部位不恒定，部位不恒定，性质易变。性质易变。性质易变。性质易变。They are rather high pitched,musical and They are rather high pitched,musical and They are rather high pitched,musical and They are rather high pitched,musical and continuous sound heard in both inspiratory and continuous sound heard in both inspiratory and continuous sound heard in both inspiratory and continuous sound heard in both inspiratory and expiratory phases.expiratory phases.expiratory phases.expiratory phases.(二)干啰音：dry rales（rhonchi）3 3.分类分类分类分类：高调干啰音高调干啰音高调干啰音高调干啰音(哨笛音哨笛音哨笛音哨笛音)sibilant rhonchi)sibilant rhonchi)sibilant rhonchi)sibilant rhonchi、起源于支气管、细支气管起源于支气管、细支气管起源于支气管、细支气管起源于支气管、细支气管低调干啰音低调干啰音低调干啰音低调干啰音（鼾音）（鼾音）（鼾音）（鼾音）sonorous rhonchisonorous rhonchisonorous rhonchisonorous rhonchi多发生在气管，主支气管。多发生在气管，主支气管。多发生在气管，主支气管。多发生在气管，主支气管。4.4.4.4.意义意义意义意义：双侧支气管哮喘，慢支炎，心源性哮喘双侧支气管哮喘，慢支炎，心源性哮喘双侧支气管哮喘，慢支炎，心源性哮喘双侧支气管哮喘，慢支炎，心源性哮喘 单侧支气管结核或肿瘤单侧支气管结核或肿瘤单侧支气管结核或肿瘤单侧支气管结核或肿瘤 四四.语音共振语音共振（vocal resonance1.1.原理原理原理原理：同语颤同语颤同语颤同语颤vocal resonance is produced in the vocal resonance is produced in the same fashion as vocal fremitus.same fashion as vocal fremitus.2.2.检查方法检查方法检查方法检查方法：嘱被检查者用一般的声音强度重复发嘱被检查者用一般的声音强度重复发嘱被检查者用一般的声音强度重复发嘱被检查者用一般的声音强度重复发“yi”“yi”长音，长音，长音，长音，喉部发音产生的振动经气管、支气管、肺泡传至胸壁，由喉部发音产生的振动经气管、支气管、肺泡传至胸壁，由喉部发音产生的振动经气管、支气管、肺泡传至胸壁，由喉部发音产生的振动经气管、支气管、肺泡传至胸壁，由听诊器听及。听诊器听及。听诊器听及。听诊器听及。四四.语音共振语音共振（vocal resonance)3.3.语音共振增强及分类语音共振增强及分类语音共振增强及分类语音共振增强及分类：*支气管语音支气管语音支气管语音支气管语音 bronchophony bronchophony：*胸语音胸语音胸语音胸语音 pectoriloquy pectoriloquy：*羊鸣音羊鸣音羊鸣音羊鸣音 egophony:egophony:*耳语音耳语音耳语音耳语音 whispered:whispered:四种语音均可见于肺实变，羊语音多见于胸腔积液上方受压四种语音均可见于肺实变，羊语音多见于胸腔积液上方受压四种语音均可见于肺实变，羊语音多见于胸腔积液上方受压四种语音均可见于肺实变，羊语音多见于胸腔积液上方受压 肺区：耳语音对诊断肺实变及其范围价值更具重要意义。肺区：耳语音对诊断肺实变及其范围价值更具重要意义。肺区：耳语音对诊断肺实变及其范围价值更具重要意义。肺区：耳语音对诊断肺实变及其范围价值更具重要意义。四四.语音共振语音共振（vocal resonance)4.4.singnificance singnificance singnificance singnificance：increasedincreasedincreasedincreased:1 consolidation of lung 1 consolidation of lung 1 consolidation of lung 1 consolidation of lung 2 large cavity formation 2 large cavity formation 2 large cavity formation 2 large cavity formation 3 Compressed atelectassis 3 Compressed atelectassis 3 Compressed atelectassis 3 Compressed atelectassis decreasd:decreasd:decreasd:decreasd:bronchial obstructionbronchial obstructionbronchial obstructionbronchial obstruction pleural effusion pleural effusion pleural effusion pleural effusion pleural thickening pleural thickening pleural thickening pleural thickening pulmonary emphsema pulmonary emphsema pulmonary emphsema pulmonary emphsema五五.胸膜摩擦音胸膜摩擦音pleural friction rub 1.1.1.1.发生原理发生原理发生原理发生原理：胸膜炎症胸膜炎症胸膜炎症胸膜炎症纤维蛋白渗出沉积于胸膜纤维蛋白渗出沉积于胸膜纤维蛋白渗出沉积于胸膜纤维蛋白渗出沉积于胸膜胸膜变胸膜变胸膜变胸膜变粗糙粗糙粗糙粗糙深呼吸，出现胸膜摩擦音。深呼吸，出现胸膜摩擦音。深呼吸，出现胸膜摩擦音。深呼吸，出现胸膜摩擦音。It is present It is present It is present It is present whenever there is acute fibrinous pleurisy of any whenever there is acute fibrinous pleurisy of any whenever there is acute fibrinous pleurisy of any whenever there is acute fibrinous pleurisy of any cause.cause.cause.cause.2.2.2.2.检查方法检查方法检查方法检查方法：深呼吸动作，在前下侧胸壁和腋窝下部听诊。深呼吸动作，在前下侧胸壁和腋窝下部听诊。深呼吸动作，在前下侧胸壁和腋窝下部听诊。深呼吸动作，在前下侧胸壁和腋窝下部听诊。五五.胸膜摩擦音胸膜摩擦音pleural friction rub3 3 3 3 听诊特点听诊特点听诊特点听诊特点：*听诊部位以前下侧胸壁最清楚听诊部位以前下侧胸壁最清楚听诊部位以前下侧胸壁最清楚听诊部位以前下侧胸壁最清楚*听诊器加压，深呼吸听诊更清楚听诊器加压，深呼吸听诊更清楚听诊器加压，深呼吸听诊更清楚听诊器加压，深呼吸听诊更清楚*可变性大，时消时现，屏住呼吸可消失可变性大，时消时现，屏住呼吸可消失可变性大，时消时现，屏住呼吸可消失可变性大，时消时现，屏住呼吸可消失 .意义意义意义意义：Its clinical significance are the same as friction Its clinical significance are the same as friction Its clinical significance are the