Дыхательные шумы: классификация и аускультация.

Respiratory sounds, also known as lung sounds or breath sounds, are the specific sounds generated by the movement of air through the respiratory system. These may be easily audible or identified through auscultation of the respiratory system through the lung fields with a stethoscope as well as from the spectral characteristics of lung sounds. These include normal breath sounds and added sounds such as crackles, wheezes, pleural friction rubs, stertor, and stridor. Description and classification of the sounds usually involve auscultation of the inspiratory and expiratory phases of the breath cycle, noting both the pitch (typically described as low (≤200 Hz), medium or high (≥400 Hz)) and intensity (soft, medium, loud or very loud) of the sounds heard. Normal breath sounds can also be identified by patterns of sound duration and the quality of the sound as described in the table below:
Name Continuous/discontinuous Frequency/pitch Inspiratory/expiratory Quality Common Causes Example Wheeze or rhonchi continuous high (wheeze) or lower (rhonchi) expiratory or inspiratory whistling/sibilant Caused by narrowing of airways, such as in asthma, chronic obstructive pulmonary disease, foreign body. Stridor continuous high inspiratory, expiratory, or both whistling/sibilantepiglottitis, foreign body, laryngeal edema, croup Inspiratory gasp continuous high inspiratory whoop pertussis (whooping cough) see New England Journal of Medicine, Classic Whooping Cough sound file, Supplement to the N Engl J Med 2004; 350:2023 2026 Crackles (rales) continuous high (fine) or low (coarse) inspiratory cracking/clicking/rattling pneumonia, pulmonary edema, tuberculosis, bronchitis, heart failure Pleural friction rubdiscontinuouslowinspiratory and expiratorymany repeated rhythmic soundsinflammation of lung linings, lung tumors not available Hamman's sign (or Mediastinal crunch) discontinuous neither (heartbeat) crunching, rasping pneumomediastinum, pneumopericardium not availableGruntingContinuouslowexpiratorysnoringsurfactant deficiency, pneumonia, cardiac abnormalities

Rales: Small clicking, bubbling, or rattling sounds in the lungs. They are heard when a person inhales. They are believed to occur when air opens alveoli. Rales can also be described as moist, dry, fine, and coarse. Rhonchi are coarse rattling respiratory sounds, usually caused by secretions in bronchial airways. The sounds resemble snoring. "Rhonchi" is the plural form of the singular word "rhonchus". Wheezing: High pitched sounds produced by narrowed airways. They are most often heard when a person breathes out (exhales). Wheezing and other abnormal sounds can sometimes be heard without a stethoscope.