日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Japanese Society of Pediatric Cardiology and Cardiac Surgery Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Pediatric Cardiology and Cardiac Surgery 32(2): 129-140 (2016)
doi:10.9794/jspccs.32.129

ReviewReview

専門医に必要な小児循環器系身体診察(Physical examination)および身体所見(Physical finding)のポイントPhysical Examination and Physical Findings for Pediatric Cardiologists

倉敷中央病院小児科Kurashiki Central hospital, Department of Pediatrics ◇ Okayama, Japan

発行日:2016年3月1日Published: March 1, 2016
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小児循環器専門医に必要な小児循環器領域の身体診察(Physical examination)の位置づけおよび身体所見(Physical findings)のポイントについて解説する.身体診察の位置づけとして重要な点は,1)問診,2)身体診察,3)検体検査,4)画像検査の4つの診断手段から病態モデル(診療仮説)を作成することである.得られた病態モデル(診療仮説)から再度所見を説明する.身体診察に必要な基本的事項として,心周期,3つの主要な心拡大の要因(短絡,弁逆流,心筋障害),心臓の位置を理解しておくと身体診察が進めやすくなる.さらに,身体所見を心血管系の大きさや内圧を推測するつもりで診察する.4つの心腔,4つの大血管の圧曲線や心腔の容積をイメージするように所見をとり,それをもとに診断を行い(診断仮説を作る),診断をもとにさらに身体所見を説明することが重要である.

The aim of this article is to describe the physical examination and physical findings for pediatric cardiologists. The most important point is to build a diagnostic hypothesis from four diagnostic methods (medical examination by interview, physical examination, laboratory examination, and diagnostic imaging). Subsequently, the findings should be explained by the diagnostic hypothesis. We can more easily conduct a physical examination when we understand the basic concepts, i.e., the cardiac cycle, the three major mechanisms of cardiomegaly (shunt lesions, valvular regurgitation, and myocardial damage), and the anatomical position of the great vessels and cardiac chambers. We estimate the size and pressure of vessels and cardiac chambers while conducting a physical examination. The physical findings should also be explained by the diagnostic hypothesis that is built each time. If the findings cannot be explained by the hypothesis, we should build the hypothesis again.

Key words: physical examination; diagnostic hypothesis; hemodynamics

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This page was last modified on 2016-04-12T11:52:54.976+09:00


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