臨床醫(yī)學英語翻譯:心臟的物理檢查2

(1) Opening snap (OS). An opening snap of the mitral valve is frequently heard in mitraI stenosis. The opening snap arises from the stiff mitral valve's snapping toward the let~ ventricle in early diastole. The opening snap is best heard in the fourth intercostal space halfway between the apex and the left sternal border. The interval between S2 and the OS is related to the severity of mitral stenosis. The more severe the stenosis, the shorter the S2-OS interval.

（1)開瓣音（OS) 二尖瓣狹窄病人通�？陕牭蕉�尖瓣開瓣音。它是舒張早期通往左心室的硬化二尖瓣發(fā)出的一種捻發(fā)音，在心尖和胸骨左緣間的第四肋間隙很清楚。S2和開瓣音間隔時間跟二尖瓣狹窄程度有關，狹窄越嚴重，S2-OS間期就越短。

(2) Ejection clicks. Ejection clicks are high-pitched sounds occurring in early systole. They are associated with stenosis of either the aortic or the pulmonic valve, with hypertension or dilatation of either the aorta or the pulmonary artery or both. Aortic clicks are best heard at the apex, while pulmonic clicks are most audible at the left. upoer sternal border. Pulmonic clicks vary with respiration and are best heararduring expiration. Aortic clicks do not vary with respiration.

（2)噴射性喀喇音 噴射性喀喇音音調(diào)高，出現(xiàn)于收縮早期，與主動脈瓣或肺動脈瓣狹窄有關，也與主動脈瓣或肺動脈瓣或兩者的高血壓或膨脹有關。主動脈瓣喀喇音在心尖區(qū)聽得最清楚，肺動脈瓣喀喇音則在胸骨左上緣最能聽到。肺動脈瓣喀喇音可隨呼吸發(fā)生變化，在呼氣時聽得最清楚。呼吸不會導致主動脈瓣喀喇音變化。

(3) Midsystolic (nonejection) clicks. Midsystolic clicks often accompanied by a late systolic murmur occur m patients with prolapse of the posterior leaflet of the mitral valve. The clicks may result from sudden tensing of the chordae tendineae or snapping of the prolapsing leaflet. The clicks may be single or multiple and may occur at any time during systole, although they generally come later than ejection clicks.

（3)收縮中期（非噴射性)喀喇音 通常伴有晚期收縮期雜音，見于二尖瓣后小葉脫垂病人,緣于腱索的突然緊繃或小葉脫垂時的喀嚓聲�？�喇音可呈單一或多樣性�？沙霈F(xiàn)于收縮期任何時候，但通常會晚于噴射性喀喇音。

6. Systolic murmurs.

6、收縮期雜音

Systolic murmurs are classified according to their time of occurrence, sound quality, and duration. The most fundamental distinction is between systolic ejection murmurs and pansystolic murmurs. Ejection murmurs ordinarily occur in midsystole. Early and late systolic murmurs also occur and should be distinguished from ejection murmurs. Ejection murmurs begin after S1 and are usually crescendo-decrescendo ("diamond-shaped'), ending before S2. Pansystolic murmurs begin with S1, extend throughout systole, and are characteristically uniform in intensity Systolic ejection murmurs have been likened to the chug of a steam engine laboring up a hill, while pansystolic murmurs have been likened to the high-pitched wail of the engine's whistle.

根據(jù)其出現(xiàn)時間、聲音性質(zhì)及持續(xù)時間對收縮期雜音進行分類。最基本是要分清收縮期噴射音和全收縮期雜音。噴射音一般出現(xiàn)在收縮中期。在收縮早期或晚期也會出現(xiàn)雜音，應與噴射音相區(qū)別。噴射音始于S1后，通常有漸強-漸弱特征，并于S2前結束。全收縮期雜音與S1同時開始，貫穿整個收縮期，它被比作蒸汽機爬山時發(fā)出的“嘎嚓”聲，全收縮期雜音則被比作蒸氣機氣笛的尖嘯聲。醫(yī)學全.在線.網(wǎng).站.提供

(1) Systolic ejection murmurs (SEMs). SEMs begin after the semilunar (aortic and pulmonic) valves open at the end of isovolumic systole. Their intensity parallels the amount of blood being ejected through the stenosis, peaking in midsystole. SEMs arise in the following settings: aortic or pulmonic stenosis, dilatation of the aorta or pulmonary artery, distal to the valve, increased rate of ventricular ejection (heart block, fever, anemia, exercise, thyrotoxicosis), and healthy individuals.

(1)收縮期噴射音（SEM) 在isovolumic收縮期末,半月形（主動脈和肺動脈)瓣打開，隨后出現(xiàn)收縮期噴射性雜音。其強度與噴過狹窄部位的血液量相當，在收縮中期達到最高。收縮期噴射音出現(xiàn)于下例情形中：主動脈瓣或肺動脈瓣狹窄；主動脈或肺動脈瓣遠端擴張；心室噴射率增加；和健康人體。

(2) Pansyatolic murmurs. Pansystolic murmurs occur when blood flows through a ventricular septal defect, or retrograde through the mitral or tricuspid valve. The even intensity and long duration of these murmurs reflect the large pressure difference across the orifice where the sound originates. The murmur continues as long as pressure in the chamber of origin exceeds that in the recipient chamber.

(2) 全收縮期雜音 當血流經(jīng)過室間隔缺損或反流經(jīng)過二尖瓣或三尖瓣時發(fā)生全收縮期雜音。雜音的平均強度和長持續(xù)時間反映出聲口壓力差異很大。只要發(fā)出室壓力超過接收室，雜音就會繼續(xù)存在。

(3) Early and late systolic murmurs. Early systolic murmurs begin with or shortly after S1 and end by midsystole. They have been reported in: mitral stenosis (etiology unclear, either coexistent mitra) regurgitation or distortion of the mitral valve apparatus), small ventricular septal defects, and individuals without cardiac disease.醫(yī)學 全在.線提供www.med126.com

(3) 收縮早期和晚期雜音 收縮期早期雜音伴隨或略后于S1出現(xiàn)，至收縮中期結束。在下例病癥中曾有此類雜音的報告：二尖瓣狹窄（病因不明，同時伴有二尖瓣反流或二尖瓣變形)；輕度室間隔缺損；及無心臟疾病個體。

Late systolic murmurs begin in midsystole and extend to or through S2. They may be heard in mitral valve prolapse (frequently accompanied by midsystolic clicks) or coarctation of the aorta.

收縮期晚期雜音始于收縮期中期，延至或貫穿S2。可在二尖瓣脫垂（通常伴有收縮中期喀喇音)或主動脈瓣縮縫時聽到。

(4) Summary. Systolic murmurs arising from the right side of the heart generally increase with inspiration while those originating on the left side decrease or do not change. Many systolic murmurs are totally innocent (as in pregnant women, growing children, and individuals with abnormal chest configuration).

(4) 總結 原于心臟右側的收縮期雜音一般隨吸氣增強；原于左側的則減弱或無變化。很多收縮期雜音是完全無害的（如妊娠婦女、發(fā)育期兒童、胸腔結構異常者)。

Diastolic murmurs are classified according to their position in diastole as early, mid, or late. An alternative classification emphasizes etiology: regurgitant murmurs from semilunar insufficiency versus ventricular filling murmurs. Regurgitant murmurs are generally early diastolic whereas ventricular filling murmurs occur in mid and late diastole.

舒張期雜音依據(jù)其舒張部位分位早期、中期和晚期。另一種分類則著重于其病因：由半月瓣閉鎖不全所致的回流性雜音對心室充盈性雜音�；亓餍噪s音一般出現(xiàn)于舒張早期，而心室充盈性雜音一般出現(xiàn)于舒張中晚期。

(1) Early diastolic murmurs. Early murmurs begin immediately after S2. The most common causes are aortic or pulmonic valve regurgitation. The murmur is usually high-pitched and blowing in quality with a decrescendo configuration. The intensity of the murmur reflects the size of the valvular leak, the acoustic properties of the chest, and the pressure difference across the valve. The distinction between pulmonic and aortic regurgitation may be extremely hard to make and may require catheterization for definitive determination.

(1) 早期舒張性雜音 早期雜音緊隨S2發(fā)生。最常見的原因是主動脈瓣或肺動脈瓣反流。雜音呈高音調(diào)、吹風樣、漸降型。其強度提示瓣膜泄漏面積、胸腔聲學特征、及穿過瓣膜的壓力差異。肺動脈瓣和主動脈瓣反流的分辨很難，需通過插管才能確診。

(2) Mid and late diastolic murmurs. Mid and late diastolic murmurs are produced by forward flow of blood through the AV (mitral and tricuspid) valves. They arise from either augmented blood flow or a stenosed valve. As a rule the murmur is low-pitched and rumbling in quality~ It does not begin until the valve from which it originates opens (sometimes with an audible snap) and ventricular pressure has fallen below atrial pressure in early diastole. Conditions in which mid or late diastolic murmurs may arise include: mitral or tricuspid stenosis, left atrial myxoma, mitral regurgitation (increased flow), and large left-to-right shunts (increased flow).

(2) 舒張中期和晚期雜音 舒張中晚期雜音是在血液前行經(jīng)過AV（二尖瓣和三尖瓣)瓣膜時產(chǎn)生的，要么是因為血流的增加，要么是因為瓣膜變窄。雜音一般呈低音調(diào)、轆轆樣，只有當產(chǎn)生雜音的瓣膜張開（有時可聽到喀嚓聲)、舒張早期心室壓力降至低于心房壓力后才會出現(xiàn)。可導致舒張中晚期雜音的病癥包括：二尖瓣或三尖瓣狹窄；左心房粘液瘤；二尖瓣反流（流量增加)及大量的左-右分流（流量增加)。

8. Continuous murmurs.

Murmurs are considered continuous when they are audible throughout all phases of the cardiac cycle. They generally arise when a continuous pressure differential allows blood to flow constantly from a high to a low pressure area, as may occur in a variety of congenital defects, most commonly patent ductus arteriosus, anomalous origin of the left coronary artery, or coronary arteriovenous fistula. Other conditions that may cause continuous murmurs include ruptured aneurysm of a sinus of Valsalva, proximal coronary artery stenosis, and pulmonary artery branch stenosis.

整個心動周期都可以聽到的雜音被稱為連續(xù)性雜音。一般出現(xiàn)在持續(xù)壓力差使血液從一高壓區(qū)不斷流向低壓區(qū)時，也可以出現(xiàn)在一些有先天性缺陷的病，最常見的有動脈導管未閉、左冠狀動脈起端異常，或冠狀靜脈動脈瘺�？赡軐е鲁掷m(xù)性雜音的其他病癥有：瓦爾薩爾瓦動脈瘤的竇破裂，近端冠狀動脈狹窄，及肺動脈支狹窄。

An analogous phenomenon is the venous hum, This continuous, low-pitched murmur results from increased velocity of venous blood flow. It is an innocent finding, usually heard in the lower anterior portion of the neck. Venous hum is accentuated by deep inspiration in most patients and may be obliterated by the Valsalva maneuver or by pressure on the internal jugular vein.

類似的一個現(xiàn)象是靜脈嗡鳴音。這種持續(xù)的低音調(diào)雜音起源于靜脈血流速的增加，對健康無害，可在頸前下部聽到。多數(shù)病人在深吸氣時靜脈嗡鳴音明顯，用瓦爾薩爾瓦手法或按壓頸內(nèi)靜脈即或消除。