2024年3月13日发(作者：)

常见呼吸系统疾病症状体征

一、以大叶分布的肺脏炎性病变，病理改变分为三期，充血期﹑实变期﹑消散期。

Lobar pneumonia is defined as an infection of lung parenchyma with a lobar distribution of

consolidation. Its pathological changes could be divided into three stages, which include

congestion, consolidation and resolution.

症状 Symptoms

青壮年，诱因，起病急

Young adults with motivation, sudden onset.

寒颤﹑高热﹑胸痛﹑咳嗽﹑铁锈色痰

Chills, high fever, chest pain, cough, rusty sputum.

体征 signs

急性热病容，呼吸困难，口唇疱疹。

Face of acute ill and fever, dyspnea, herpes labialis

视诊：呼吸动度减弱

Inspection: decrease of respiratory movement

触诊：语音振颤增强，气管居中

Palpation: increase of vocal fremitus, trachea in middle position

扣诊：浊音

Percussion: dullness

听诊：管状呼吸音，胸膜摩擦音，湿罗音

Auscultation: bronchial breath sound, pleural friction rub, rales.

二﹑慢性阻塞性肺病

(chronic obstructive pulmonary disease COPD)

慢性阻塞性肺病是一种具有气流受限特征的肺部疾病，气流受限不完全可逆，呈进行性发展。

确切的病因还不十分清楚，但认为与肺部对有害气体或有害颗粒的异常炎症反应有关。

COPD has been defined as a disease characterized by the presence of airflow limitation, which is

partially reversible and generally progressive. The exact cause of COPD still remains unclear,

but mostly is associated with abnormally pulmonary inflammatory response to the harmful gases

or particles.

症状：Symptoms

慢性咳嗽，咳痰，白色粘液泡沫痰，合并感染时可为脓性, 冬季加剧.

Chronic productive cough,

whitish mucoid frothy sputum, yellowish sputum when complicated with infection.

aggravation in the winter,

气短或呼吸困难, 喘息

short of breath or dyspnea, wheezing, dyspnea with exertion.

体征：signs

1. 视诊: 胸廓呈桶状，肋间隙增宽，呼吸动度减弱

Inspection: barrel chest, decrease of respiratory movement

2. 触诊：语颤减弱

Palpation: decrease of vocal fremitus.

3. 叩诊：双肺叩诊呈过清音，肺下界下降，心界缩小，肝浊音界下移

Percussion: bilateral hyperresonance

4. 听诊：肺泡呼吸音减弱，散在干湿罗音

Auscultation: decrease of breath sounds and diffused rhonchi and rales

三、支气管哮喘(bronchial asthma)

是由多种细胞（如嗜酸性粒细胞，肥大细胞，T细胞，中性粒细胞，气道上皮细胞等）和细

胞组分参与的气道慢性炎症性疾病。这种慢性炎症导致气道反应性增加，通常出现广泛多变

的可逆性气流受限，并引起反复发作性的喘息，气急，胸闷或咳嗽等症状，常在夜间和（或）

清晨发作，加剧，多数患者可自行缓解或经治疗缓解。

Bronchial asthma is a chronic inflammatory disorder of the airway in which many cells and

cellular components play a role, in particular mast cells, eosinophils, T-lymphocytes, neutrophils,

epithelial cells and so forth. This chronic inflammation causes airway hyperresponsiveness and

recurrent episodes of wheezing, breathlessness, chest tightness, and cough, particularly at night

and/or in the early morning. These symptoms are usually associated with widespread but variable

airway limitation that is reversible either spontaneously or with treatment.

症状Symptoms

1. 幼年或青年期发病，反复发作，季节性。

Childhood or adolescence onset, recurrent attacks and seasonality.

2. 过敏原接触史，过敏性鼻炎症状

Contact of allergen, allergic rhinitis

3. 胸闷，带有哮鸣音的呼气性呼吸困难

Chest tightness, expiratory dyspnea with wheezing

4. 症状可经治疗缓解或自行缓解

Remission spontaneously or with treatment.

体征Signs

1. 视诊：呼气性呼吸困难，被迫端坐位，辅助呼吸肌参与呼吸，大汗，紫绀，胸廓饱

满，呈吸气位。

Inspection: expiratory dyspnea, forced sitting position, accessory respiratory muscle use,

sweating, cyanosis, chest hyperinflation.

2. 触诊：呼吸动度变小，语颤减弱

Palpation: decrease of respiratory movement and fremitus.

3. 叩诊：过清音

Percussion: hyperresonant note

4. 听诊：两肺满布干罗音

Auscultation: diffused rhonchi.

四、胸腔积液(pleural effusion)

胸膜毛细血管内静水压增高，胶体渗透压降低或胸膜毛细血管通透性增加所致胸膜液体产生

增多或吸收减少，使胸膜腔内积聚的液体较正常为多。

胸腔积液的性质可分为渗出液和漏出液。

Pleural effusion is defined as the abnormal accumulation of fluid within the pleural space. It may

be caused by an either excess fluid production or decreased absorption, which are associated with

increased pleural capillaries hydrostatic pressure or decreased oncotic pressure or increased

pleural capillaries permeability.

The character of pleural fluid can be divided into exudates and transudate.

症状：Symptoms

1. ＜300ml症状不明显

The symptoms are not obvious when the fluid is less than 300ml

2. 干咳，胸痛。胸液增多时胸痛减轻

Dry cough, pleuritic chest pain, the pain will be palliated when the fluid increase

3. ＞500ml气短﹑胸闷

short breath and chest tightness when the fluid is over 500ml

4. 大量胸腔积液 呼吸困难﹑发绀

dyspnea and cyanosis when the fluid is large.

5. 基础疾病症状

symptoms of the basic disease.

体征Signs

1. 少量胸液常无体征

Usually there is no signs if the fluid is <500ml

2. 中至大量积液

Middle to large fluid

视诊：呼吸受限，肋间饱满

Inspection: restriction of the respiratory movement on the affected side, bulging intercostals

margins

触诊：心尖搏动及气管移向健侧，语颤减弱

Palpation: shift of apex beat and trachea to the uninvolved side.

absent tactile fremitus over effusion

叩诊：积液区浊音或实音

Percussion: dullness on the effusion area.

听诊：积液区呼吸音减弱或消失，积液区上方可

听到支气管呼吸音，纤维索性胸膜炎可听

到胸膜摩擦音

Auscultation：Decreased or absent breath sounds over the effusion.

Bronchial breath sounds could be heard above the pleural effusion.

pleural rub could be heard in dry or fibrinous pleurisy

五﹑气胸(pneumothorax)

空气进入胸腔. Air in the pleural space

根据病因可分为；Can be classified as follows according to the causative factors

1. 自发性气胸：阻塞性肺气肿﹑肺结核等

spontaneous pneumothorax: COPD, pulmonary tuberculosis.

2. 人工气胸：

artificial pneumothorax

3. 外伤性气胸：

traumatic pneumothorax

根据胸膜破裂的情况，临床分为；

classified clinically as follows according to the pleural hole

1. 闭合性 closed pneumothorax

2. 交通性 open pneumothorax

3. 张力性 tension pneumothorax.

症状Symptoms

1. 诱因：

motivation (strenuous exertion)

2. 突发一侧胸痛伴呼吸困难

sudden onset with unilateral pleuritic pain and dyspnea. The degree of dyspnea varies

according to the size of the pneumothorax and the lung’s healthy condition

3. 患者基础肺功能好，小量闭合性气胸，仅有轻度气急，数小时后可逐渐平稳

small closed pneumothorax with a good basic lung function, the initial dyspnea is slight

and will improve after a few hours.

4. 大量张力性气胸 严重呼吸困难，同时可有呼吸循环衰竭的表现

large tension pneumothorax will produce sever dyspnea and even respiratory or

circulatory failure

体征 Signs

1. 少量胸腔积气常无明显体征

no obvious signs if pneumothorax is small

2. 大量积气large pneumothorax

视诊：患侧胸廓饱满，肋间隙变宽，呼吸动

度减弱

Inspection: the affected thoracic is full and the respiratory movement is restricted.

触诊：气管﹑心脏移向健侧，语颤减弱或消失

Palpation: tracheal and apex beat deviation, vocal fremitus diminished or disappeared.

叩诊：患侧呈鼓音.

Percussion: hyper-resonance on percussion

听诊：患侧呼吸音减弱或消失

Auscultation: diminution of breath sounds.

肺不张(atelectasis)

肺泡容积减少 loss of alveolar volume

1. 堵塞性肺不张 obstructive atelectasis

异物﹑肿瘤﹑痰拴﹑支气管内膜结核等

foreign body, neoplasm, sputum plug, endobronchial tuberculosis

2. 非堵塞性肺不张 non-obstructive atelectasis

压缩性（气胸﹑积液）

compressive, e.g. pneumothorax, pleural effusion

症状Symptoms: 与肺不张的范围﹑程度相关

varies according to the extent and degree of atelectasis.

呼吸困难﹑咳嗽，继发感染时有相应的中毒症状

dyspnea, cough, toxic symptom associated with secondary infection.

体征 Signs:

视诊：患侧胸廓塌陷，呼吸动度减弱

Inspection: retraction of the involved side and the respiratory movement is restricted.

触诊：心脏﹑气管移向患侧，语颤减弱，压缩性肺不张语颤可增强

Palpation: heart and tracheal shift to the affected side, vocal fremitus is decreased, but increased

in compressed atelectasis

叩诊：病肺区呈浊音

Percussion: dullness on percussion.

听诊：病肺呼吸音降低，压缩性肺不张可听到支气管肺泡呼吸音

Auscultation: diminution of breath sounds on the involved side, bronchial breath sounds could

be heard on the compressive atelectasis.

常见四种肺与胸膜疾病体征的鉴别诊断

疾病

大叶性

肺炎

肺不张

气胸

视诊

动度减弱

胸廓正常

触诊

气管居中

语颤↑

叩诊

叩浊

听诊

管状呼吸音

呼吸音减弱或消

失

呼吸音减弱或消

失

呼吸音减弱或消

失

动度减弱，胸廓塌气管移向患侧，语叩浊

陷 颤↓

动度减弱，胸廓饱气管移向健侧，语过清音

满 颤↓

动度减弱，胸廓饱气管移向健侧，语浊音或实音

满 颤↓

胸腔积液

Differential diagnosis of four common pulmonary and pleural diseases

Diseases Inspection Palpation Percussion Auscultation

Bronchial breath

sounds

Lobar pneumonia Decreased

respiratory

movement

Thorax normal

Atelectasis Decreased

movement

Thorax retracted

Decreased

movement

Thorax bulged

Decreased

movement

Thorax bulged

Trachea in the dullness

middle

Increased vocal

fremitus

Trachea shifted dullness

to the affected

side. Decreased

vocal fremitus

Trachea shifted hyperresonance

to the normal

side. Decreased

vocal fremitus

Trachea shifted dullness

to the normal

side. Decreased

vocal fremitus

Decreased or

absent breath

sounds

Decreased or

absent breath

sounds

Decreased or

absent breath

sounds

Pneumothorax

Pleural effusion