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title="醫(yī)學教育網(wǎng)" class="a1">醫(yī)學教育網(wǎng)</a> </div> <a href="javascript:void(0)" onclick="window.external.AddFavorite(location.href,document.title);" target="_self" class="collection ico fr"></a>  <div id="wbr4eq9" class="fen fr">|</div> <div id="9l4g4td" class="font_size fr ico"><a href="javascript:void(0);" target="_self" class="big lan ico">大</a><a href="javascript:void(0);" target="_self" class="small ico">小</a></div> </div> </div> </div>  <div style="width: 800px;text-align: left;margin: 0 auto;margin-bottom: 20px;"> <div style="width:800px; height:90px;"> <a href="http://pardusfixedincomebond.com/yishizigekaoshi/baoming/li2412107427.shtml" target="_blank"> <img title="報名預約" src="http://pardusfixedincomebond.com/upload/resources/image/2024/12/12/826342.png" width="800" height="90" style="border:0px;"></a> </div> </div> <div style="BORDER-BOTTOM: #7f8d98 1px dashed;BORDER-LEFT: #7f8d98 1px dashed;PADDING-BOTTOM: 8px;LINE-HEIGHT: 26px;MARGIN-TOP: -4px;MARGIN-BOTTOM: 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class="jxbox clearfix"> <p style="TEXT-INDENT: 2em">【提問】周圍血管征都見于那些疾??？</p> <p style="TEXT-INDENT: 2em">周圍血管征的發(fā)病原理是什么？</p> <p style="TEXT-INDENT: 2em">【回答】學員23391175，您好！您的問題答復如下：</p> <p style="TEXT-INDENT: 2em">周圍血管征指的是在某些疾病條件下檢查周圍血管時所發(fā)現(xiàn)的血管搏動或波形的改變臨床上常見的周圍血管征。由于周圍血管征有多種表現(xiàn)形式，其發(fā)生機理也不盡相同。</p> <p style="TEXT-INDENT: 2em">表現(xiàn)形式</p> <p style="TEXT-INDENT: 2em">1.毛細血管搏動征（capillary pulsation syndrome），又稱Quincke征，用手指輕壓患者指床末端或以清潔的玻璃片輕壓其口唇黏膜如見到紅白交替的節(jié)律性微血管搏動現(xiàn)象稱為毛細血管搏動征。</p> <p style="TEXT-INDENT: 2em">2.水沖脈（water hammer pulse）水沖脈也叫做陷落脈、速脈或Corrigan脈。檢查時將患者手臂抬高過頭并緊握其手掌腕面可感到患者脈搏驟起驟降，急促有力，有如水浪沖過，故稱為水沖脈。</p> <p style="TEXT-INDENT: 2em">3.槍擊音（pistol shot sound），也叫Traube征，正常時在頸動脈或鎖骨下動脈可聽到相當于第一心音與第二心音的兩個聲音而在其他動脈處聽不到。在病理情況下將聽診器的胸件輕放在患者的肱動脈或股動脈處可聽到“Ta-Ta”的聲音稱為槍擊音。</p> <p style="TEXT-INDENT: 2em">4.Duroziez 雙重音用聽診器鐘體型的胸件稍加壓力放于患者的股動脈根部，并使體件開口方向稍偏向近心端，聽到隨心臟收縮出現(xiàn)的收縮聲與回聲的雙重音稱為Duroziez雙重音。</p> <p style="TEXT-INDENT: 2em">5.頸動脈搏動且常伴有點頭運動（De Musset征）。</p> <p style="TEXT-INDENT: 2em">6.交替脈（pulsus alternans）交替脈為種節(jié)律正常而強弱交替出現(xiàn)的脈搏為心肌損害的一種表現(xiàn)。</p> <p style="TEXT-INDENT: 2em">7.重搏脈（dicrotic pulse）正常脈波在其下降期中有重復上升的脈波但較第個波為低不能觸及在某些病理情況下此波增高而可以觸及稱為重搏脈即個收縮期可觸及兩個脈搏搏動。</p> <p style="TEXT-INDENT: 2em">8.奇脈(paradoxical pulse）吸氣時脈搏明顯減弱甚至消失的現(xiàn)象稱為奇脈不明顯的奇脈只有在聽診血壓時方可發(fā)現(xiàn)即原來聽到的脈搏聲在吸氣時減弱或消失或收縮壓在吸氣期較呼氣期降低 1．33 kPa以上。</p> <p style="TEXT-INDENT: 2em">9..洪脈（bounding pulse）洪脈是指形態(tài)正常而振幅大的脈搏觸診血管時可發(fā)現(xiàn)脈搏強而大。</p> <p style="TEXT-INDENT: 2em">10.細脈（small pulse）細脈指形態(tài)正常而振幅小的脈搏與洪脈恰恰相反觸診時脈搏弱而小也稱做絲脈（thready Pulse）。</p> <p style="TEXT-INDENT: 2em">產(chǎn)生機制</p> <p style="TEXT-INDENT: 2em">由于周圍血管征有多種表現(xiàn)形式，其發(fā)生機理也不盡相同，導致周圍血管征出現(xiàn)的最常見疾病為主動脈瓣關(guān)閉不全。當主動脈瓣關(guān)閉不全時，心臟代償性地收縮增強，以便在收縮期有足夠的血液射入主動脈乃至全身小動脈，使收縮壓上升，脈搏強而有力，出現(xiàn)洪脈。而在心臟舒張期時，由于主動脈瓣關(guān)閉不全，主動脈內(nèi)大量血液反流人左心室，使主動脈及小動脈、毛細血管發(fā)生代償性收縮，因而動脈的收縮壓與舒張壓之差增大，形成水沖脈、槍擊音、Duroziez雙重音及毛細血管搏動征等一系列周圍血管征醫(yī)`學教育網(wǎng)搜集整理。</p> <p style="TEXT-INDENT: 2em">當有<a href="http://pardusfixedincomebond.com/jibing/xiuke/" target="_blank" title="休克" class="hotLink">休克</a>、主動脈瓣狹窄等一些疾病存在時，心排血量下降，可出現(xiàn)細脈，系由于循環(huán)血量不足造成血管內(nèi)血流量減少所致。</p> <p style="TEXT-INDENT: 2em">交替脈的出現(xiàn)是心室收縮強弱交替的結(jié)果，為心肌損害的一種表現(xiàn)，見于嚴重的<a href="http://pardusfixedincomebond.com/jibing/gaoxueya/" target="_blank" title="高血壓" class="hotLink">高血壓</a>性<a href="http://pardusfixedincomebond.com/jibing/xinzangbing/" target="_blank" title="心臟病" class="hotLink">心臟病</a>和冠狀動脈粥樣硬化性<a href="http://pardusfixedincomebond.com/jibing/xinzangbing/" target="_blank" title="心臟病" class="hotLink">心臟病</a>。</p> <p style="TEXT-INDENT: 2em">奇脈產(chǎn)生的機理較為復雜，常見于心包炎時，為心包填塞的一個重要體征，其發(fā)病機制如下：</p> <p style="TEXT-INDENT: 2em">正常情況下，吸氣時肺循環(huán)血量增加，但由于體循環(huán)向右心的灌注亦相應增加，因而肺循環(huán)向左心回流的血量無明顯變化，使得脈搏大小變化亦不明顯。但在心包填塞時，雖然吸氣時肺淅血量增加，可由于心室舒張受限，體循環(huán)回心血量不能相應增加，造成肺循環(huán)向左心回流的血量減少，左心室射血量也因此減少，使脈搏變?nèi)跎踔劣|不到，即形成奇脈。</p> <p style="TEXT-INDENT: 2em">動脈導管未閉、主動脈瓣關(guān)閉不全、肥厚型梗阻性<a href="http://pardusfixedincomebond.com/jibing/xinjibing/" target="_blank" title="心肌病" class="hotLink">心肌病</a>等疾病可出現(xiàn)重搏脈，與周圍血管緊張度下降及外周阻力減低等多種因素有關(guān)。</p> <p style="TEXT-INDENT: 2em">祝您學習愉快！</p> <p style="TEXT-INDENT: 2em">祝您順利通過考試！</p> <p style="TEXT-INDENT: 2em">感謝您對網(wǎng)校的支持！ </p> <p style="TEXT-INDENT: 2em">★問題所屬科目：<a href="http://pardusfixedincomebond.com/linchuangyishi/" target="_blank" title="臨床執(zhí)業(yè)醫(yī)師" class="hotLink">臨床執(zhí)業(yè)醫(yī)師</a>---心血管系統(tǒng)</p> </div> </div>  <div style="margin-bottom:10px;"> <p align="center"> <img src="/upload/resources/image/2024/11/05/820261.jpg" alt="執(zhí)業(yè)醫(yī)師考試公眾號" border="0"> </p> </div>    <div id="40so80i" class="share new-share clearfix"> <div id="l4iv4br" class="info-share-new fl"> <div id="zwyw40t" class="snltxt fl">分享到：</div> <div id="rbvmbjt" class="fl" id="share-2020" data-sites="wechat, qzone, weibo, qq"></div> </div> <div id="nw9r05q" class="jc fr"></div> </div>  <div id="phm4kg9" class="xgzx clearfix"> 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