Ощупывание

    Ощупывание (пальпация — palpatio) — это метод диагностики, основанный на чувстве осязания, а так же на чувстве объемности. Ощупывание проводят пальцами рук, но при этом обязательно участвует кисть, а так же вся рука. При пальпации определяются физические свойства тех или иных органов
или образований. А именно:

  • их местоположение;
  • величина;
  • границы;
  • конфигурация (или форма);
  • характер поверхности;
  • плотность (или консистенция);
  • подвижность (или смещаемость).

    При помощи пальпации исследуют пульс, сердечный толчок. Кроме того при пальпации можно судить о чувствительности или болезненности образований, которые исследуются.Об этом можно судить по словам больного или по их реакции на боль.
    Пальпация — метод старый, еще у Гиппократа встречаются указания на ощупывании печени и селезенки. В конце XIX и начале XX века этот метод применительно внутренних органов был усовершенствован русскими клиницистами, особенно В. П. Образцовым. С первого взгляда пальпация метод довольно простой, но в действительности требует большого опыта и умения. У разных лиц чувство осязания развито неодинаково. Так же значительную трудность представляет толкование получаемых с помощью пальпации данных.
    Для успешности необходимо соблюдать ряд технических условий:
     Положение пациента.  Оно должно быть таким, при котором можно легче всего найти доступ к тем или иным органам. В зависимости от того, какие органы ощупываются, положение может быть различным: лежачее, на боку, стоячее, на четвереньках. Одним из основных моментов, мешающих ощупыванию внутренних органов, служит напряжение мышечного слоя. Для расслабления этого напряжения приходится предложить пациенту изменить положение туловища и конечностей. Так, для расслабления мышц брюшной стенки пациента, лежа на спине, должен согнуть ноги в тазобедренных и коленных суставах.Много лет назад в случае необходимости допускалась
пальпация даже в теплой ванне, так как в этом случает мышцы максимально расслаблялись.
     Положение врача.  Оно должно быть удобным, так как в этом случае обеспечивается свобода движений. Особенно важно, чтобы
удобно располагались руки, так как они быстро устают и осязательные ощущения притупляются. Целесообразно, чтобы врач сидел справа от пациента, чтобы видеть его лицо (это дает возможность видеть реакцию на возможную боль). Необходимо, чтобы предплечья врача находились в горизонтальном положении на уровне тела пациента.
     Руки  исследующего должны быть теплыми, гибкими, а ногти коротко острижены. Движения легкие и вместе с этим осторожные. При ощупывании необходимо руководствоваться дыхательными движениями пациента. Чтобы пальпирующая рука проникала вглубь, нужно пользоваться моментом выдоха. Момент вдоха так же должен быть использован для диагностических заключений. Кроме того, смещение при дыхании пальпируемого тела служит одним из очень важных признаков для диагностики. Дышать пациент должен глубоко, через рот, притом пользуясь брюшным типом дыхания. Для устранения спазма мышц желательно отвлекать внимание пациента отвлеченным разговором.

    Способы пальпации внутренних органов.
    Различают поверхностную и глубокую пальпацию.
   Поверхностная  пальпация совершается ладонями, свободно положенными плашмя; ощупываемая область почти не надавливается. Этот способ хорошо проводить при первичном (ориентировочном) исследовании соответствующей области.
     Глубокая  пальпация является основным методом исследования. Она совершается пальцами с соответствующим давлением.
     Скользящая  пальпация (метод Образцова). При этом кончики пальцев проникают вглубь постепенно, во время выдоха, последовательно происходит
ощупывание всего участка. Прощупываемый орган придавливается к задней стенке брюшной полости. Скользящее движение производят не на коже, а вместе с кожей.
    Проникающая  пальпация. При этом два-три пальца руки проникают глубоко на каком-нибудь ограниченном пространстве. Практикуется для выяснения болевых точек.
      Бимануальная  пальпация. Ощупывание проводится двумя руками. Левой рукой исследуемая область приближается к правой. Такая пальпация
позволяет охватить обеими руками исследуемое тело: матку, почку, опухоль и так далее.
     Баллотирующая  пальпация (толчкообразная). При этом тремя-четырьмя пальцами, прижатыми друг к другу и установленными на соответствующем участке, производят несколько сильных и коротких толчков. Такой способ подходит для обнаружения в брюшной полости жидкости и для ощупывания почек.

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не в сети 7 месяцев

Андрей

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