Winter R, Smethurst D
Adult Intensive Care Unit, Queen's Medical Centre, University Hospital, Nottingham, UK.
Br J Anaesth. 1999 Dec;83(6):960-1. doi: 10.1093/bja/83.6.960.
We describe a new clinical sign in a case series of three patients who developed pneumothoraces during mechanical ventilation in the intensive care unit. All three patients were in the supine position. Two patients had x-rays that were inconclusive before insertion of chest drains and the third had a pneumothorax diagnosed on clinical findings alone. On each occasion we were able to diagnose pneumothorax using sternal percussion and simultaneous auscultation. The method relies on percussion of the sternum while simultaneously ausculating the anterior (superior) chest on the side of the suspected pneumothorax. The stethoscope is then placed on the other side of the chest. The percussion sound on the affected side has an exaggerated, resonant and booming quality. The percussion note is exaggerated partly because a stethoscope is used and partly because, in the supine patient, air localizes upwards to the anterior thorax.
我们在一个病例系列中描述了一种新的临床体征，该病例系列包含三名在重症监护病房接受机械通气期间发生气胸的患者。所有三名患者均处于仰卧位。两名患者在插入胸腔引流管之前，胸部X光片结果不明确，第三名患者仅根据临床检查结果就被诊断为气胸。每次我们都能够通过胸骨叩诊和同步听诊来诊断气胸。该方法是在叩击胸骨的同时，对疑似气胸一侧的前胸（上部）进行听诊。然后将听诊器放在胸部的另一侧。患侧的叩诊音具有夸张、共鸣且响亮的特点。叩诊音之所以会夸张，部分原因是使用了听诊器，部分原因是仰卧位患者的空气向上聚集在前胸。
