血管檢查ppt課件

1、血管檢查,北京安貞醫(yī)院十五病房 李昭,血管檢查是心血管檢查的重要組成部分，分為以下幾個(gè)部分：脈搏(Pulse)血壓(Blood pressure)血管雜音(Vascular bruit)周圍血管征(Peripheral vascular sign),脈搏(Pulse),A person's pulse is the arterial palpation of a heartbeat. It can be felt

2、in any place that allows for an artery to be compressed against a bone, such as at the neck (Carotid Artery), at the wrist(Radial artery), behind the knee (Popliteal aretery), on the inside of the elbow (Brachial artery)

3、, and near the ankle joint(Posterior tibial artery). The pulse rate can also be measured by measuring the heart beat directly (Auscultation), usually using a stethoscope.主要用觸診(Palpation)：橈動(dòng)脈(Radial artery)、肱動(dòng)脈(Brachial

4、 artery)、股動(dòng)脈(Femoral artery)、頸動(dòng)脈(Carotid Artery)及足背動(dòng)脈(Dorsalis pedis artery)。正常人兩側(cè)脈搏差異很小，某些疾病可有明顯不同：縮窄性大動(dòng)脈炎(Constrictive Aortoarteritis)或無(wú)脈癥(Pulseless disease)。,,脈率(Pulse rate)類似心率(Heart rate)。A normal pulse rate f

5、or a healthy adult, while resting, can range from 60 to 100 beats per minute (BPM) .Generally, pulse rates are higher in infants and young children. 生理、病理及藥物影響可使脈率增快或減慢。還應(yīng)觀察脈率與心率是否一致。某些心律失常如心房顫動(dòng)(Atrial fibrillation

6、)或頻發(fā)期前收縮(Extrasystole)，脈率可少于心率。,,脈律(Pulse Rhythm)反應(yīng)心臟節(jié)律(Heart Rhythm) 正常人脈律規(guī)整，竇性心律不齊(Sinus arrhythmia)可隨呼吸(Breath)改變，吸氣(Inspiratory)時(shí)增快，呼氣(Expiration)時(shí)減慢Respiratory Sinus Arrhythmia(RSA): is a naturally occurring vari

7、ation in heart rate that occurs during a breathing cycle. Heart rate increases during inspiration and decreases during expiration.,,房顫(Atrial fibrillation)患者脈律絕對(duì)不規(guī)則(Irregular)，脈搏強(qiáng)弱不等，脈率少于心率，后者稱之為脈搏短絀(Pulse shortage)；期前收縮

8、(Extrasystole)呈二聯(lián)律，三聯(lián)律可形成二聯(lián)脈(Pulsus bigeminus )，三聯(lián)脈。二度房室傳導(dǎo)阻滯(Atrioventricular block)可有脈搏脫落，稱脫落脈(dropped pusle)。Atrial fibrillation is usually accompanied by symptoms related to a rapid heart rate.,Conduction,Sinus rhyth

9、m,Atrial fibrillation,In AF, the normal electrical impulses that are generated by the sinoatrial node(竇房結(jié)) are overwhelmed by disorganized electrical impulses that originate in the atria(心房) and pulmonary veins(肺靜脈), lea

10、ding to conduction of irregular impulses to the ventricles that generate the heartbeat.,,緊張度與動(dòng)脈壁狀態(tài)脈搏的緊張度與動(dòng)脈硬化(Arteriolosclerosis)程度有關(guān)。檢查方法：兩個(gè)手指指腹置于橈動(dòng)脈(Radial artery)上，近心端手指用力按壓阻斷血流，使遠(yuǎn)心端觸不到脈搏，通過(guò)施加壓力的大小及感覺(jué)的血管壁彈性狀態(tài)判斷脈搏緊張度

11、。,,強(qiáng)弱與心搏出量(Cardiac output) 、脈壓(Pulse pressure)及外周血管阻力(Peripheral vascular resistance)有關(guān)。脈搏增強(qiáng)及振幅大，由于心搏量大、脈壓寬和外周阻力低有關(guān)，見(jiàn)于高熱(High fever )、甲狀腺功能亢進(jìn)(Hyperthyroidism)、主動(dòng)脈瓣關(guān)閉不全(Aortic insufficiency)；脈搏減弱及振幅低，由于心搏量少、脈壓小和外周阻力高有關(guān)，

12、見(jiàn)于心力衰竭(Heart failure )、主動(dòng)脈瓣狹窄(Aortic stenosis)與休克(Shock)等。,,The strength of the pulse can also be reported:0 = Absent 1 = Barely palpable 2 = Easily palpable 3 = Full 4 = Aneurysmal(動(dòng)脈瘤) or Bounding pulse(洪脈) Bo

13、unding pulse is a medical sign characterized as a bounding and forceful pulse that quickly disappears. Occurs normally with heavy exercise劇烈運(yùn)動(dòng), pregnancy懷孕, alcohol consumption飲酒, or high anxiety焦慮. A bounding pulse is a

14、lso often associated with high blood pressure and large stroke volume(每搏輸出量), and can occur with many pathological conditions, including:Heart failure 心衰, Aortic regurgitation 主動(dòng)脈瓣關(guān)閉不全, Atherosclerosis動(dòng)脈粥樣硬化 , Anemia貧血 ,

15、 Fever發(fā)熱.,,脈波正常脈波，由升支（叩擊波）ascending、波峰（潮波）和降支（重搏波）descending組成。升支，左室收縮早期，左室射血(Left ventricular ejection)沖擊動(dòng)脈壁(Arterial wall)所致；波峰，收縮中、晚期，血液向動(dòng)脈遠(yuǎn)端運(yùn)行同時(shí)，部分逆反，沖擊動(dòng)脈壁引起；降支，左室舒張期，源于主動(dòng)脈瓣關(guān)閉，血液由外周向近端折回后又向前，以及主動(dòng)脈壁彈性回縮(Recoil) ，使血流

16、持續(xù)流向外周動(dòng)脈所致。明顯主動(dòng)脈硬化(Atherosclerosis)者，重搏波趨于不明顯。,,,水沖脈（Water hammer pusle）：驟起驟落，猶如潮水漲落，故名水沖脈。是由于周圍血管擴(kuò)張(Peripheral vasodilation)或存在分流、反流(Shunt, reflux)所致。前者見(jiàn)于甲亢(Hyperthyroidism )、嚴(yán)重貧血(Severe anemia )、腳氣病(Beriberi )；后者見(jiàn)于主動(dòng)

17、脈關(guān)閉不全(Aortic valve regurgitation )，先心病動(dòng)脈導(dǎo)管未閉(Patent ductus arteriosus )，動(dòng)靜脈瘺(Arteriovenous fistula)。檢查時(shí)，握緊手掌腕面(Palm side of wrist )，前臂(Forearm)高舉過(guò)頭，可明顯感覺(jué)橈動(dòng)脈(Radial artery)猶如水沖的急促而有力的脈搏沖擊。Watson's water hammer p

18、ulse is the medical sian which describes a pulse that is bounding and forceful, as if it were the hitting of a water hammer that was causing the pulse.This is associated with increased stroke volume(每搏輸出量) of the left

19、ventricle and decrease in the peripheral resistance leading to the widened pulse pressure(脈壓) of aortic regurgitation(主動(dòng)脈瓣關(guān)閉不全 ).,,交替脈（Pulsus alternans）：節(jié)律規(guī)整(Regular rhythm)而強(qiáng)弱交替(Alternating strong and weak)的脈搏，必要時(shí)需患者在呼

20、氣中期屏住呼吸(Hold breath) ，以排除呼吸變化影響的可能性。Pulsus alternans is a physical finding with arterial pulse waveform showing alternating strong and weak beats. It is almost always indicative of left ventricular systolic impairment(

21、左室收縮功能受損), and carries a poor prognosis(預(yù)后).一般認(rèn)為交替脈為左室收縮力(Left ventricular contractility)強(qiáng)弱交替所致，為左心衰竭(Left heart failure)的重要體征之一。常見(jiàn)于高血壓性心臟病(Hypertensive heart disease )、急性心肌梗死(Acute myocardial infarction)和主動(dòng)脈瓣關(guān)閉不全(Ao

22、rtic insufficiency)等。,Pulsus alternans,Pulse pressure waveform displaying the variation in pressure between beats in pulsus alternans.,D.H.Lawrence, in his famous novel, “sons and lovers" elegantly describes pulsus

23、alternans:"Then he felt her pulse. There was a strong stroke and a weak one, like a sound and its echo. That was supposed to betoken the end.",,奇脈（Paradoxical pulse）：吸氣時(shí)脈搏明顯減弱或消失，左心室搏出量減少所致。當(dāng)有心臟壓塞(Cardiac tamp

24、onade)或心包縮窄(Pericardial constriction)時(shí)，吸氣時(shí)右心舒張受限(Limited right ventricular diastolic )，回心血量減少(Reduction of venous return)而影響右心排量(Right cardiac output )，右心室排入肺循環(huán)血量(Pulmonary blood volume)減少，另一方面肺循環(huán)受吸氣時(shí)胸腔負(fù)壓(Thoracic negati

25、ve pressure)的影響，肺血管擴(kuò)張，致使肺靜脈(Pulmonary vein)回流左心房(Left atrium)血量減少，左心排血減少。這些因素形成吸氣時(shí)脈搏減弱，甚至不能觸及，故又稱“吸停脈”。明顯的奇脈觸診時(shí)即可按知。,,Paradoxical pulse (PP), also paradoxic pulse and pulsus paradoxus, is an exaggeration of the normal va

26、riation in the pulse during the inspiratory phase of respiration, in which the pulse becomes weaker as one inhales and stronger as one exhales. It is a sign that is indicative of several conditions including cardiac tamp

27、onade, pericarditis, chronic sleep apnea, croup, and obstructive lung disease (e.g. asthma, COPD).,,無(wú)脈（pulseless）：即脈搏消失，可見(jiàn)于嚴(yán)重休克(Severe shock)及多發(fā)大動(dòng)脈炎(Multiple arteritis )，后者為某一部位動(dòng)脈閉塞(Artery occlusion)而致相應(yīng)部位脈搏消失。,血壓（Blood

28、pressure）,Blood pressure (BP) is a force exerted by circulating blood on the walls of blood vessels, and is one of the principal vital signs. During each heartbeat, BP varies between a maximum (systolic) and a minimum (d

29、iastolic) pressure. The mean BP, due to pumping by the heart and resistance in blood vessels, decreases as the circulating blood moves away from the heart through arteries.,,測(cè)量方法 (Measurement) 直接測(cè)壓法(Invasive measurement

30、)：經(jīng)皮穿刺(Percutaneous)將導(dǎo)管(Catheter)從周圍動(dòng)脈(Peripheral artery)送入主動(dòng)脈(Aorta)，末端接監(jiān)護(hù)測(cè)壓系統(tǒng)(Pressure Monitoring System)。優(yōu)點(diǎn)：精確；缺點(diǎn)：有創(chuàng)操作。僅適用于危重、疑難病例。Arterial blood pressure (BP) is most accurately measured invasively through an arteri

31、al line. Invasive arterial pressure measurement with intravascular cannulae(套管) involves direct measurement of arterial pressure by placing a cannula needle(套管針 ) in an artery (usually radial, femoral, dorsalis pedis or

32、brachial). This procedure can be done by any licensed doctor or a respiratory Therapist.,,間接測(cè)量法(Noninvasive measurement)：袖帶加壓法(Cuff pressure method)，以血壓計(jì)測(cè)量(Sphygmomanometer )。The non invasive auscultatory and oscillomet

33、ric measurements(示波測(cè)量) are simpler and quicker than invasive measurements, require less expertise in fitting, have virtually no complications(幾乎沒(méi)有任何并發(fā)癥), and are less unpleasant and painful for the person. However, nonin

34、vasive methods may yield somewhat lower accuracy and small systematic differences in numerical results. Non-invasive measurement methods are more commonly used for routine examinations and monitoring.,操作規(guī)程：椅子上休息至少15分鐘，

35、取坐位或仰臥位測(cè)血壓，被檢者上肢裸露并輕度外展，肘部置于心臟同一水平，將氣袖均勻緊貼皮膚纏于上臂，使其下緣在肘窩以上約2~3cm，氣袖之中央位于肱動(dòng)脈表面，檢查者觸及肱動(dòng)脈搏動(dòng)后，將聽(tīng)診器體件置于搏動(dòng)上準(zhǔn)備聽(tīng)診。然后，向袖帶內(nèi)充氣，邊充氣邊聽(tīng)診，待肱動(dòng)脈搏動(dòng)消失后再升高30mmHg，緩慢放氣，雙眼隨汞柱下降，平視汞柱表面，根據(jù)聽(tīng)診結(jié)果得出血壓值。,,Auscultatory methodThe auscultatory method

36、(from the Latin word for listening) uses a stethoscope(聽(tīng)診器) and a sphygmomanometer(血壓計(jì)). This comprises an inflatable cuff(袖帶) placed around the upper arm at roughly the same vertical height as the heart, attached to a m

37、ercury or aneroid manometer(無(wú)液血壓計(jì)). The mercury(水銀) manometer measures the height of a column of mercury, giving an absolute result without need for calibration(校準(zhǔn)), and consequently not subject to the errors and drift o

38、f calibration which affect other methods. The use of mercury manometers is often required in clinical trials and for the clinical measurement of hypertension in high risk patients, such as pregnat women.A cuff of approp

39、riate size is fitted smoothly and snugly(緊貼), then inflated manually by repeatedly squeezing a rubber bulb until the artery is completely occluded(閉塞). Listening with the stethoscope to the brachial artery at the elbow,

40、the examiner slowly releases the pressure in the cuff. When blood just starts to flow in the artery, the turbulent flow creates a “whooshing” or pounding (first korotkoff sound). The pressure at which this sound is first

41、 heard is the systolic BP(收縮壓). The cuff pressure is further released until no sound can be heard (fifth Korotkoff sound), at the diastolic arterial pressure(舒張壓).,,血壓至少應(yīng)測(cè)量?jī)纱危g隔1~2分鐘，如收縮壓或舒張壓2次讀數(shù)差別5mmHg以上，應(yīng)再測(cè)量，3次讀數(shù)的平均值作為

42、測(cè)量結(jié)果。脈壓(Pulse pressure):收縮壓與舒張壓的差值。平均動(dòng)脈壓(Mean arterial pressure, MAP)：舒張壓加1/3脈壓。偶爾會(huì)出現(xiàn)聽(tīng)診間隙（在收縮壓與舒張壓之間出現(xiàn)的無(wú)聲間隔），可能因未能識(shí)別導(dǎo)致收縮壓被低估，主要見(jiàn)于重度高血壓或主動(dòng)脈瓣狹窄等。需注意向袖帶內(nèi)充氣時(shí)肱動(dòng)脈搏動(dòng)聲消失后，再升高30mmHg，氣袖寬度：大小應(yīng)適合患者的上臂臂圍，至少應(yīng)包裹80%的上臂。手臂過(guò)于粗大或大腿血壓

43、，用標(biāo)準(zhǔn)氣袖測(cè)值會(huì)過(guò)高；反之，手臂太細(xì)或兒童測(cè)壓時(shí)用標(biāo)準(zhǔn)氣袖，數(shù)值會(huì)偏低。為保證數(shù)值準(zhǔn)確，需使用適當(dāng)大小的氣袖。,,Korotkoff 5期法：第1期 代表收縮壓 首先聽(tīng)到的響亮的拍擊音第2期 隨后拍擊有所減弱和帶有柔和的吹風(fēng)樣雜音第3期 拍擊音增強(qiáng)和雜音消失第4期 音調(diào)變?yōu)槌翋灥?期 代表舒張壓 聲音消失妊娠婦女、嚴(yán)重貧血、甲狀腺功能亢進(jìn)、主動(dòng)脈瓣關(guān)閉不全及Korotkoff不消失者，可以第4期作為舒張壓讀

44、數(shù)，或者記錄兩個(gè)數(shù)值，如血壓160/80~50mmHg,,Five types of Korotkoff sounds:The first Korotkoff sound is the snapping sound first heard at the systolic pressure. Clear tapping, repetitive sounds for at least two consecutive beats is co

45、nsidered the systolic pressure. The second sounds are the murmurs heard for most of the area between the systolic and diastolic pressures. The third = A loud, crisp tapping sound.The fourth sound, at pressures within

46、10 mmHg above the diastolic blood pressure, were described as "thumping" and "muting". The fifth Korotkoff sound is silence as the cuff pressure drops below the diastolic blood pressure. The disappea

47、rance of sound is considered diastolic blood pressure- two points below the last sound heard.,血壓標(biāo)準(zhǔn),中國(guó)高血壓防治指南（2005）,若患者收縮壓與舒張壓分屬于不同級(jí)別時(shí)，以較高的分級(jí)為準(zhǔn)；單純收縮期高血壓也可按照收縮壓水平分為1、2、3級(jí)。,血壓變動(dòng)的臨床意義,高血壓(Hypertension)：Hypertension is a chr

48、onic medical condition in which the blood pressure is elevated. It is also referred to as high blood pressure or shortened to HT, HTN or HPN. The word "hypertension", by itself, normally refers to systemic,arte

49、rial hypertension. 情緒激動(dòng)(Emotional )、緊張(Tension )、運(yùn)動(dòng)(Sports)等。安靜清醒的條件下采用標(biāo)準(zhǔn)測(cè)量方法，至少3次非同日血壓值達(dá)到或超過(guò)收縮壓140mmHg和（或）舒張壓90mmHg，即可認(rèn)為有高血壓，如果僅收縮壓達(dá)到標(biāo)準(zhǔn)成為單純收縮期高血壓(Isolated systolic hypertension )。,,Hypertension can be classified as

50、either essential (primary)(原發(fā)性高血壓)or secondary(繼發(fā)性或癥狀性高血壓). Essential or primary hypertension means that no medical cause can be found to explain the raised blood pressure and represents about 90-95% of hypertension case

51、s.Secondary hypertension indicates that the high blood pressure is a result of (i.e., secondary to) another condition, such as kidney disease or tumours (adrenal adenoma 腎上腺腺瘤 or pheochromocytoma嗜鉻細(xì)胞瘤 ). 高血壓是動(dòng)脈粥樣硬化(Ath

52、erosclerosis)和冠心病(Coronary Heart Disease)重要危險(xiǎn)因素，也是心力衰竭(Heart failure)的重要原因。,,低血壓(Hypotension)： If blood pressure is lower than normal then it is called as low blood pressure or hypotension.Low blood pressure causes can

53、 be due to hormonal changes（激素變化）, widening of blood vessels, medicine side effects, anemia（貧血）, heart & endocrine problems（內(nèi)分泌失調(diào)）. 凡血壓低于90/60mmHg時(shí)稱低血壓，持續(xù)低血壓狀態(tài)多見(jiàn)于嚴(yán)重病癥，如休克(shock)、心肌梗死(Myocardial infarction)、急性心臟壓塞(A

54、cute cardiac tamponade)等。也可是體質(zhì)因素，一般無(wú)癥狀。另外，如果患者平臥5分鐘以上后站立1min和5min，收縮壓下降20mmHg以上，伴有頭暈或暈厥，為直立性低血壓(Orthostatic hypotension).,,雙上肢血壓差別顯著：正常雙側(cè)上肢血壓差別5~10mmHg，超過(guò)此范圍屬于異常，見(jiàn)于多發(fā)性大動(dòng)脈炎(Takayasu)或先天性動(dòng)脈畸形(Congenital arterial malformati

55、on)等。,,上下肢血壓差異常：正常下肢血壓(Lower extremity blood pressure)高于上肢血壓(Upper extremity blood pressure)20~40mmHg，如下肢血壓低于上肢血壓應(yīng)考慮主動(dòng)脈縮窄(Coarctation of the aorta )，或胸腹主動(dòng)脈型大動(dòng)脈炎(Aortic arteritis)等。,,脈壓改變：脈壓明顯增大，結(jié)合病史，可考慮甲狀腺功能亢進(jìn)(Hyperthyro

56、idism )、主動(dòng)脈瓣關(guān)閉不全(Aortic insufficiency)和動(dòng)脈硬化(Arteriosclerosis)等。若脈壓減少，可見(jiàn)于主動(dòng)脈瓣狹窄(Aortic stenosis )、心包積液(Pericardial effusion)和嚴(yán)重的心力衰竭(Severe heart failure )。If pulse pressure is consistently greater than 40 mmHg, e.g. 60

57、 or 80 mmHg, the most likely basis is stiffness of the major arteries, aortic regurgitation (a leak in the aortic valve), hyperthyroidism or some combination. If the pulse pressure is genuinely low, e.g. 25 mmHg or les

58、s, the cause may be low stroke volume(每搏輸出量), as in Congestive Heart Failure(充血性心力衰竭) and/or shock,aortic or pericardial effusion(心包積液).,動(dòng)態(tài)血壓監(jiān)測(cè),ABPM measures blood pressure at regular intervals throughout the day and nig

59、ht. It is believed to be able to reduce the white coat hypertension effect.24小時(shí)記錄血壓白晝時(shí)間6am~10pm，15或20min測(cè)量一次晚間為10pm~次晨6am，30min測(cè)量一次國(guó)內(nèi)正常參考標(biāo)準(zhǔn)：24小時(shí)平均血壓值<130/80mmHg；白晝平均值<135/85mmHg；夜間平均值<125/75mmHg。正常情況下，夜間血壓值

60、較白晝低10~15%。疑有診所高血壓（Hypertension Clinic,白大衣高血壓white coat hypertension) 、隱蔽性高血壓(Hidden hypertension )、頑固難治性高血壓(refractory hypertension )、發(fā)作性高血壓或低血壓以及降壓治療效果差的患者，均應(yīng)考慮做動(dòng)態(tài)血壓監(jiān)測(cè)作為常規(guī)血壓的補(bǔ)充手段。,Ambulatory blood pressure monitoring，

61、ABPM,血管雜音及周圍血管征,靜脈雜音(Venous hum)：靜脈壓力低，一般多不明顯，臨床上較有意義的有頸靜脈營(yíng)營(yíng)聲（無(wú)害性雜音），在頸根部近鎖骨處，甚至在鎖骨下，尤其右側(cè)，低調(diào)、柔和、連續(xù)性雜音，坐位及站立位明顯，為頸靜脈血液快速回流至上腔靜脈(Superior vena cava )。以手指輕輕壓迫頸靜脈暫時(shí)中斷血流，雜音即可消失，屬無(wú)害性雜音。需與甲亢之血管雜音和某些先心病的雜音鑒別。此外，肝硬化門靜脈高壓(Portal h

62、ypertension)引起腹壁靜脈曲張(Abdominal wall veins)時(shí)，可在臍周或上腹部聞及連續(xù)性靜脈營(yíng)營(yíng)聲。Venous hum is a benign(良性) medical condition where 20% of the blood flow travels to the brain and back to the heart. Due to the large amount of blood it ca

63、n move quite fast causing the vein walls to vibrate which can create a humming noise to be heard by the patient.,,動(dòng)脈雜音(Arterial bruits)：多見(jiàn)于周圍動(dòng)脈(Peripheral artery )、肺動(dòng)脈(Pulmonary artery)和冠狀動(dòng)脈(Coronary artery)。甲亢時(shí)甲狀腺側(cè)葉的連續(xù)性

64、雜音(Continuous noise )，多見(jiàn)，局部血流豐富；多發(fā)大動(dòng)脈炎的狹窄病變部位可聽(tīng)到收縮期雜音；腎動(dòng)脈狹窄(Renal artery stenosis )，上腹部或腰部聞及收縮期雜音；肺內(nèi)動(dòng)靜脈瘺(Pulmonary arteriovenous fistula )，在胸部相應(yīng)部位有連續(xù)性雜音；外周動(dòng)靜脈瘺(Peripheral arteriovenous fistula)時(shí)則在病變部位出現(xiàn)連續(xù)性雜音；冠狀動(dòng)靜脈瘺(Coron

65、ary arteriovenous fistula)時(shí)可在胸骨下端出現(xiàn)表淺而柔和的連續(xù)性雜音或雙期雜音；,,周圍血管征：槍擊音（pistol shot sound）：在外周較大動(dòng)脈表面，常選擇股動(dòng)脈(Femoral artery )，輕放聽(tīng)診器膜型體件(Stethoscope membrane body parts)時(shí)可聞及與心跳一致短促射槍的聲音。,,Duroziez's ‘s sign: a double sound he

66、ard over the femoral artery when it is compressed distally.Duroziez雙重雜音：以聽(tīng)診器膜型體件稍加壓力于股動(dòng)脈可聞及收縮期與舒張期雙期吹風(fēng)樣雜音(Two-phase noise)。毛細(xì)血管搏動(dòng)征(capillary pulsation: pulsation of the capillary bed in the nail) ：手指輕壓患者甲床末端或以玻片輕壓患者口唇粘

67、膜，使局部發(fā)白，當(dāng)心臟收縮和舒張時(shí)則發(fā)白的局部邊緣發(fā)生有規(guī)律的紅、白交替改變即為毛細(xì)血管搏動(dòng)征。,,In the case of aortic regurgitation, the blood seeps back(回流) into the heart through a failing aortic valve. This means that the high pressure isn't maintained in the

68、 system anymore. You get a high pressure when the heart is contracting, but not when it's relaxed.This is felt as a pulsation in the nailbed, which you can feel by pressing on top of the nail. It's not an easy