Percussion

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diagnostic method

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Percussion refers to tapping a surface part of the body with hands to make it vibrate mechanically and produce sound according to Mechanical wave The characteristics of sound can be used to judge whether the organ state of the inspected part is abnormal diagnostic method 。 According to the purpose and technique of percussion, it can be divided into direct percussion and indirect percussion.^[1]

Chinese name: Percussion
According to characteristics: Mechanical wave Sound characteristics
Operation steps: Knock a surface part of the body by hand to make it vibrate mechanically and produce sound

Classification: Direct percussion and indirect percussion
Role: It can also be used to judge whether this part is normal or not, and can also be used to judge the pathological changes of organ boundaries

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principle

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Percussion is performed by hand or Percussion hammer Knock some parts of the body to cause the organs below the part to produce different resonance sounds, and judge whether the part is normal according to the nature and interval of the sound. It can also be used to judge the pathological changes of organ boundaries.

Percussion is also often used to examine certain joint parts to diagnose Neuroreflex Whether it is normal.

method

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According to the purpose and technique of percussion, it can be divided into direct percussion and indirect percussion.

1. The direct percussion method is called direct percussion method, in which three fingers in the middle of the doctor's right hand are close together, and the palm of the doctor is used to directly pat the inspected part. The method of judging the pathological changes with the help of the clapping echo and fingers is called direct percussion method. It is applicable to diseases with a wide range of chest and abdomen, such as Pleural adhesion Or thickening, large amount Hydrothorax Or ascites and pneumothorax.

2. Indirect percussion is the most widely used percussion method. The doctor shall attach the second knuckle of the left middle finger to the percussion site, and slightly lift the other fingers. Do not contact the body surface; The right hand is naturally bent, and the middle finger tip is used to knock the knuckle or the second segment of the left middle finger tip Phalange Because it is easy to contact closely with the examined part and is sensitive to the examined part. The percussion direction should be perpendicular to the body surface of the percussion site. Percussion should be performed with wrist joints And Metacarpophalangeal joint Focus on activities and avoid elbow joint and shoulder joint Participate in sports. The percussion action should be flexible short 、 Flexible 。 The middle finger of the right hand should be lifted immediately after percussion, so as not to affect the judgment of percussion sound. Percussion at the same part can be performed for 2-3 consecutive times. If no clear impression is obtained, another 2-3 consecutive times can be performed. Continuous rapid percussion should be avoided because it is not conducive to the discrimination of percussion sounds.

matters needing attention

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1. The environment should be quiet so as not to affect the judgment of percussion sound.

2. According to the different percussion positions, the patient should take appropriate positions. For example, when percussing the chest Seating or Decubitus position ； Percussion of abdomen is often taken Supine position ； Determine whether there is a small amount ascites The patient can be instructed to take Elbow knee position 。

3. Pay attention to the comparison and identification of symmetrical parts during percussion.

4. During percussion, we should not only pay attention to the changes of percussion sounds, but also to the tactile differences of different lesions. The two should cooperate with each other.

5. Percussion operation should be standardized, and the force should be uniform and appropriate. Generally, the depth of percussion can be about 5-7cm. The force of percussion should be determined according to the different examination sites, the nature of pathological tissues, the size of the scope or the depth of the location. If the focus or examination site is small or shallow, light (weak) percussion should be taken, such as determining the heart, the relative dullness boundary of the liver and the spleen boundary; When the range of the inspected part is relatively large or the position is relatively Deep time , you need to use moderate force percussion, such as determining the absolute dullness boundary of heart and liver; If the focus is about 7cm away from the body surface, heavy (strong) percussion is required.

Percussive sound

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Percussive sound (Percussion sound) The echo produced by the percussion part during percussion is called percussion sound. The difference of percussion sound depends on the Densification , elasticity Gas content And the distance from the body surface. The percussion sound depends on the wavelength of the sound (the old sound is warm, the short sound is cool) amplitude (Larger intensity of sound , the smaller one is weak) and whether Musical sound (Harmony of sound and rhythm) Dullness 、 Drum sound 、 Real sound 、 Overmute Five.^[1]

1． voiceless consonant (resonance) is the percussion sound of normal lungs. It is a kind of non musical sound with long wavelength, long duration and inconsistent sound. It suggests that the elasticity, air content and density of lung tissue are normal.

2. Dullness is a kind of non musical percussion sound with short wavelength, weak sound and short duration. In addition to sound, the sense of touch felt by the fingers is also weak. It occurs when tapping the parenchymal organs covered by a small amount of air containing tissue, such as tapping the heart or liver Pulmonary segment The part covered by the edge, or Pathological state Below pneumonia Percussion sound (decreased air content in lung tissue)

3. Like beating drums, tympany is a kind of harmonious music. It is stronger than pure sound and has a longer duration. It occurs when tapping hollow organs containing a large amount of gas. Normally, it can be seen in the gastric vesicle area and abdomen, and pathologically, it can be seen in Intrapulmonary cavity 、 pneumothorax 、 pneumoperitoneum Etc.

4. Flatness is a kind of non musical sound with shorter wavelength, weaker sound and shorter duration than voiced sound, such as the sound produced by tapping heart, liver and other substantive organs. It can be seen in a large number of pathological conditions Pleural effusion or Pulmonary consolidation Etc.

5. Hyper silence is between drum sound and voiceless sound, which belongs to the category of drum sound. Its wavelength is relatively clear Sound length It is a kind of musical sound, which is stronger than the voiceless sound. It is a kind of morbid percussion sound that normal adults do not have. Clinically, it is common when the air content of lung tissue increases and elasticity decreases, such as emphysema 。 Normal children can knock out relatively clear sounds.

Percussion sound and its characteristics are shown in the table below:

Percussive sound	strength	wavelength	Duration	Normal parts
voiceless consonant	strong	long	long	Normal lung
Dullness	Strong	Shorter	Shorter	The part of the heart and liver covered by the lung margin
Drum sound	strong	short	longer	Gastric vesicle area and abdomen
Real sound	weak	short	short	Parenchymal organ
Overmute	Stronger	Longer	Longer	It does not appear in normal adults, but can be seen in emphysema

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