Joshi N
Section of General Internal Medicine, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey 17033, USA.
South Med J. 1999 Aug;92(8):756-61. doi: 10.1097/00007611-199908000-00002.
In the current era of cost-effective delivery of health care, it is particularly timely to carefully reevaluate the clinical utility of selected physical signs. The third heart sound (S3) is one such sign that is the focus of the current review.
I conducted a computerized MEDLINE search of articles related to S3 published since 1966. For information before 1966, textbook and other cross-references from MEDLINE-identified sources were used.
The presence of S3 may be the earliest clue to the presence of left ventricular failure. It predicts a high risk of postoperative complications in the setting of noncardiac surgery and is a predictor of response to digoxin in patients with congestive heart failure. However, the interobserver variation in its detection is high even among experienced clinicians.
While the presence of S3 may have important clinical implications, high interobserver variation in detection limits its use.
在当前注重医疗保健成本效益的时代，仔细重新评估某些体格检查体征的临床效用尤为适时。第三心音（S3）就是这样一个体征，是本次综述的重点。
我对自1966年以来发表的与S3相关的文章进行了计算机化的医学文献数据库（MEDLINE）检索。对于1966年以前的信息，使用了医学文献数据库检索到的资料来源中的教科书及其他交叉参考文献。
S3的出现可能是左心室衰竭存在的最早线索。它预示着非心脏手术患者术后并发症的高风险，并且是充血性心力衰竭患者对地高辛反应的一个预测指标。然而，即使在经验丰富的临床医生中，其检测的观察者间差异也很大。
虽然S3的出现可能具有重要的临床意义，但检测中观察者间的高差异限制了其应用。
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