Determination of chest excursion (CHE). Respiratory excursions of the chest Average excursion of the chest

In men, a measuring tape is applied from behind directly to the lower corners of the shoulder blades, and from the front - along the lower edge of the isola. In women, the measuring tape is applied in front above the mammary glands, and in the back, as in men. The result obtained is recorded.

Chest circumference (CHC) is measured in three phases: during normal quiet breathing, during maximum inhalation and exhalation.

Dynamometry

The subject, in a standing position, takes the dynamometer and, stretching his arm to the side, squeezes the device with all his strength. It is not allowed to move from your seat and bend your arm at the elbow joint. The study is carried out 2-3 times. The best result is recorded.

Progress:

1. Weight-height index (Quetelet)− determines how many grams of weight are for each centimeter of height:

VRI= Weight (g)

Height (cm)

The norm for girls is 325-375g, for boys 350-400g. weight.

2. Excursion of the chest − determines the difference in the size of the circles at maximum inhalation and maximum exhalation:

EGC = OGK (on inhalation) - OGK (on exhalation)

The norm for girls is 5-7 cm, for boys 7-10 cm.

3. Erisman index − determines the proportionality of the relationship between chest circumference and height. It is calculated in two steps:

a) OGK (on pause)= OGK (inhalation) + OGK (exhalation)

b) E= OGK (on pause, cm)-1/2 height (cm)

The norm for girls is 3-7 cm, for boys 5-8 cm

4. Dynamometry− determines the average strength of the muscles of the hand:

D= Arm muscle strength (kg) 100%

Body weight (kg)

The norm for girls is 45-50%, for boys 60-70%

5. Strength of physique ( according to Pigny's formula ) :

CT = Height (cm) - (Body weight (kg) + OGK in the expiratory phase (cm))

Results: less than 10 – strong physique; 10-20− good physique; 21-25− average build; 26-35− weak physique; 36 or more is very weak.

6. Compare the data obtained with the normative data, draw a conclusion about the physical development of your own body.

Control questions:

1. What basic methods for assessing physical development do you know?

2. What is physical development?

3. What groups of indicators are used when assessing physical development?

4. What is the essence of the method of comprehensive assessment of the physical development of children and adolescents?

5. What is growth?

6. What rules must be followed when measuring height?

7. How should body weight be measured?

8. What determines the weight-height index?

9. How should chest circumference be measured?

10. What determines chest excursion?

11. What does the Erisman index determine?

12. What is dynamometry?

13. What is the human constitution? What factors does it depend on?

Laboratory work No. 2

Topic: “Determination of the level of physical development of children and adolescents

centile method"

Goal of the work: become familiar with the centile method for assessing physical development.

Equipment: stadiometer, scales, centile tables.

For each sign of physical development, seven fixed centiles are given in the rating scales: 3.10, 25, 50, 75, 90 and 97.

Centile (or%) - this is the proportion of healthy children of a given sex and age with the same height or body weight. The gaps between the centiles are called “corridors”, each of which corresponds to a certain level of physical development (Table 1).

Table 1

1st centile corridor- the area of ​​“low” values ​​is recorded in children with deviations in physical development. Observation by specialists (pediatrician, pediatric endocrinologist, etc.) is indicated.

2nd centile corridor- area of ​​“reduced” values, consultation with a specialist is indicated.

3rd-5th centile corridors- the area of ​​“average” values, occurs in 80% of healthy children, and is most typical for this age and sex group.

Determination of chest and head circumference is carried out to assess the physical development of a person, mainly in childhood, as well as to identify certain diseases associated with the respiratory system. The correct algorithm for taking measurements is carried out by a doctor, his assistant or a nurse using special equipment and appropriate devices. Lung volume is measured using a spirometer.

Measuring chest circumference in adult men and women

The chest circumference is measured using a measuring tape in a standing position. The person must be at rest. To do this, the chest is freed from outer clothing, preferably also underwear, in order to obtain the most accurate measurement. The correct application of the measuring tape should be along the lower edge of the shoulder blades on the back side and along the level of the 4th rib in front. If you look at external signs, then in men this parameter is measured at the level of the nipples, and in women at the base of the mammary glands or under them. Proper application of the tape should be snug, but without excessive tension. It is laid in a strictly horizontal position. In an adult, upon reaching a certain age, the development and growth of the chest stops. Changes can only occur if there are pathological processes in the patient’s body.

For children in the first year of life, this procedure is mandatory; it allows us to determine the individual characteristics and level of physical development of the child for his age.

It is worth noting that usually the average chest circumference in men and boys is 5 cm higher than in women and girls. However, there are a number of reasons that can affect the spread of these values, as a result of which it may turn out that the chest of a woman or girl has high indicators, and this will also be the norm, without any associated pathologies.

Together with the chest circumference, the head circumference is measured. The child is seated on a chair or laid down. At the back, the measuring tape is located along the maximum protrusion of the occipital protuberance, at the front - along the superciliary arches. The growth of the chest occurs especially rapidly in the first years of a child’s life and is highly dependent on body weight. During the first 12 months of life, the size of a newborn's chest will increase by an average of 13 centimeters, which is equal to 50% of the growth in body length over the same period of time. In babies, chest circumference is measured in a supine position. This approach applies to children who are at least 2 years old.

There are average values ​​for changes in chest and head circumference. Anthropometric data are calculated for men and women from birth to adulthood:

Age	Chest circumference in boys, cm	% from body length	Head circumference in boys, cm	% of body length	Chest circumference in girls, cm	% of body length	Head circumference in girls, cm	% of body length
At the time of birth	33	68	36	68	31	66	35	67
1 month	35	66	37	66	34	65	36	67
2 months	37	66	38	66	36	65	37	68
3 months	38	66	41	65	37	65	39	68
6 months	42	64	43	65	40	64	41	65
9 months	44	64	45	63	43	64	44	64
1 year	45	62	46	62	46	63	45	61
2 years	50	58	47	56	51	60	46	56
3 years	51	55	49	51	51	58	47	52
4 years	52	51	50	50	53	56	49	50
5 years	54	51	51	46	54	53	50	47
6 years	56	49	52	44	56	52	51	43
7 years	57	47	53	42	58	50	51	42
8 years	58	46	53	40	59	47	51	44
9 years	60	46	54	39	62	49	51	45
10 years	63	45	54	39	63	48	52	40
11 years	65	45	54	38	67	48	53	37
12 years	67	46	55	36	70	48	53	35
13 years	70	47	55	35	75	48	54	34
14 years	75	47	55	34	77	49	54	33
Adult	88	50	56	33	83	50	55	32

Leveling can occur either upward or downward. During an appointment at the doctor's office, chest excursion is measured. This is done by subtracting the exhalation values ​​from the inhalation values. Normally, it ranges from 5 to 10 cm. Deviations from it may raise questions about lung problems. People involved in sports may also have increased values ​​between the upper and lower values ​​by 3-5 centimeters. A general increase in lung volume is observed in professional athletes and can significantly exceed the average value of up to 30% or more.

The vital capacity of the lungs is a functional indicator that determines the capabilities of the human respiratory system. Measurements are taken using a medical device (spirometer). A person stands exactly on a horizontal surface and exhales with maximum force into the spirometer mouthpiece. A total of 3 such measurements are carried out for a more accurate result. The indicators are added and divided by the resulting figure. The measurement accuracy is rounded to 100 cm³.

Determination of lung volume

To evaluate the obtained indicators, use the Ludwig formula:

• Calculation for men: vital capacity = 40*height (cm)+30*weight (kg) -4400;

• Calculation for women: vital capacity = 40*height (cm)+10*weight (kg) -3800.

For the formula, you can use the indicators from the table:

Weight, kg	Height, cm
	160	170	180	190	200
	50	3000	3300	3600	3900	4200
60	3300	3600	3900	4200	4500
70	3600	3900	4200	4500	4800
80	3900	4200	4500	4800	5100
90	4200	4500	4800	5100	4400
100	4500	4800	5100	5400	5800

With age, deviations occur towards a decrease in lung volume, including due to a decrease in the level of activity compared to young people.

Bottom line

Chest circumference, volume and excursion are directly related to the level of physical development of a person and is the most important indicator of health, but there is a reasonable limit to everything and it is worth sticking to the golden mean so as not to injure yourself with excessive loads or their complete absence.

Changes in the shape of the chest are caused by movements of the ribs and diaphragm.

Movement of the ribs. The ribs are connected by movable joints with bodies And transverse processes

Sh PART VI. BREATH

vertebrae Through these two fixation points there passes an axis around which the ribs can rotate. When the ribs rise as a result of contraction of the inspiratory muscles, the size of the chest increases both laterally and in the anteroposterior direction (Fig. 21.2, A). Accordingly, when the ribs descend, the volume of the chest decreases.

The axis of rotation of the upper ribs is located almost transverse; As for the axis of rotation of the lower ribs, it takes more sagittal position . In this regard, during inhalation, the upper parts of the chest increase mainly in the anteroposterior direction, and the lower parts in the lateral direction. In addition, raising the lower ribs leads to a greater increase in chest volume.

There is a simple method of measuring mobility chest. It consists in determining the circumference of the chest at maximum inspiration and

maximum exhalation. The centimeter is passed directly through the armpits; in this case, the subject must keep his hands at his sides. In healthy young men, the difference between the chest circumference in the inhalation and exhalation positions should be 7-10 cm, and in women - 5-8 cm.

The raising of the ribs during inhalation is caused mainly by contractions external intercostal muscles(Fig. 21.2, B). Their fibers are oriented in such a way that the point of attachment to the underlying rib is located further from the center of rotation than the point of attachment to the overlying rib. In this regard, when such muscles contract, a greater moment of force acts on the underlying rib, and it is pulled towards the overlying one. As a result, the chest rises due to the external intercostal muscles. Under normal conditions, most internal intercostal muscles participates in the act of exhalation. The fibers of these muscles are oriented in such a way that when they contract, the overlying rib is pulled towards the underlying one, and the entire chest is lowered.

When it is necessary to strengthen the activity of the respiratory apparatus, in particular with difficulty breathing, auxiliary muscles can be included in addition to the main ones. To the accessory inspiratory muscles refers to all the muscles attached to the bones of the shoulder girdle, skull or spine and capable of elevating the ribs. The most important of them are big And pectoralis minor, scalenes, sternocleidomastoid and, in part, gear muscles (Fig. 21.3). In order for these muscles to participate in the act of inhalation, it is necessary that their attachment sites be fixed. A typical example is the behavior of a patient with difficulty

CHAPTER 21. PULMONARY BREATHING 569

breathing. Such patients rest their hands on a stationary object, as a result of which their shoulders are fixed, and tilt their head back. The most important auxiliary expiratory muscles include abdominal muscles, pulling the ribs down and squeezing the abdominal organs, which at the same time shift upward along with the diaphragm.

Movement of the diaphragm. The most important of the major respiratory muscles is the diaphragm, innervated by the phrenic nerves (from segments C 3 -C 5). Normally, the diaphragm has the shape of a dome, protruding into the chest cavity. During exhalation, it is adjacent to the inner wall of the chest along approximately three ribs (Fig. 21.4). During inhalation, the diaphragm flattens as a result of contraction of its muscle fibers and moves away from the inner surface of the chest. This opens up spaces called costophrenic sinuses, due to which the areas of the lungs located in the area of ​​​​these sinuses expand and are especially well ventilated.

Movement of the lower border of the lungs can be detected by percussion chest. Below this limit, a dull sound is detected, which is associated with the attenuation of sound vibrations in the tissues of the abdominal organs. Above the border of the lungs, i.e. above the air-saturated lung tissue, the percussion sound is clearer. This way you can determine the border of the lungs during maximum inhalation and exhalation. In healthy young people, this limit at maximum inspiration should be at least three intercostal spaces lower than at maximum exhalation.

Types of breathing. Depending on whether the expansion of the chest is associated with normal breathing

predominantly with elevation of the ribs or flattening of the diaphragm, distinguished costal (thoracic) And abdominal mud breathing. In the thoracic type, breathing is ensured mainly by the work of the intercostal muscles, and the diaphragm moves to a certain extent passively in accordance with changes in intrathoracic pressure. With the abdominal type, as a result of a powerful contraction of the diaphragm, the organs of the abdominal cavity are greatly displaced, so when inhaling, the stomach “sticks out.”

Rice. 3. Weight indicators for 10th grade students in %

Rice. 4. Chest circumference of 10th grade students in %

Table 1 shows the indicators of height, weight, chest circumference, as well as chest excursion of 10th grade students.

For girls of average body type, height is calculated using the following formula: Height=6*age+76, and for boys - Height=6*age+77. Deviations from average physical values ​​should not exceed ±2.5 cm for boys and ±3.5 cm for girls. If the height obtained in the calculation is 20% more or less than the average, this may indicate endocrine disorders. Normal chest excursion is 6 to 9 cm.

ChapterII. Determination of harmonious physique

The owner of a proportional figure is considered to be a person whose all indicators are less than half, and whose waist circumference is no more than half his height. The harmony of the physique is determined by the indicator of chest development, calculated by the formula:

Chest circumference x 100

Height

With a normal physique, the value of harmonious physique is 50-55%. If this ratio is less than 50%, the physique is weak, and if it is more than 50%, it is strong.

Analysis of the results of calculations of the harmonious physique of 10th grade students showed that the majority of 10th graders - about 60% - have a normal physique, 36% - weak, 4% - strong. The data is shown in Fig. 5 and Table 2.

Rice. 5. Body harmony of 10th grade students in %

Table 2 shows not only indicators of harmonious physique (PH), but also the state of posture of 10th grade students, which will be discussed in Chapter 3.

Physical education of children and adolescents is carried out in a specific environment, the factors of which are both socio-economic and environmental conditions (E.A. Kriksunov, 1997).

Therefore, the physical condition of children, on the one hand, can be considered as a result of the influence of these conditions, and with the targeted influence of physical education - as a result of counteracting negative environmental conditions. However, we must not forget that each person is capable of independently strengthening his health and improving physical development (V.P. Pokhlebin, 1992).

Figure 6 shows that 50% of students do not monitor their health - this is a very alarming indicator, especially for this age group. 38% do not pay enough attention to their physical development: perhaps they lack theoretical knowledge to use more advanced techniques; or it is influenced by lack of time with significant school loads, lack of willpower. And finally, only 4% of schoolchildren take their lifestyle seriously and use various methods to preserve and improve their health.

Schoolchildren who are not concerned about their health at all can be advised to start small: say, do morning exercises every day, start a hardening program and do physical exercise in their free time. Psychologically, it is the most difficult to take the first step, but without it it is unthinkable to take your own health seriously.

The largest number of 10th graders should engage in individual physical improvement: play sports taking into account the individual characteristics of the body. The first step has already been taken, you should continue in the same direction.

Those schoolchildren who are serious about their health can continue to carry out their health programs.

Rice. 6. Attitude of 10th grade students to their health in %

Chapter 3. Determining correct posture

Throughout a person’s life, the ratio between organic and inorganic substances in bone tissue changes. The bones of a child have more organic substances, while those of older people have more mineral substances.

With curvature of the lumbar spine, it can develop lordosis(from the Greek lordos - curved). In this case, the spine and chest are curved, which leads to dysfunction of the respiratory and digestive systems. As a result of these diseases, a person’s metabolism decreases, increased fatigue, and headaches appear (L. P. Anastasova et al., 1997).

When posture is impaired, various pathological changes occur in the musculoskeletal system, curvature of the spine occurs, which can lead to various diseases.

Therefore, it is very important to observe hygienic rules of behavior, especially at a young age (the formation of correct posture in a person stabilizes by the age of 18). And first of all, a person must monitor his posture (Appendices 2,3).

At the second stage of work, 10th grade students determined the state of their posture (in anthropometry this method is called somatoscopic). To do this they used the formula:

A= shoulder width*100%

the size of the arch of the back,

Where A– posture indicator.

The results are shown in Table 2 (see Chapter 2) and Fig. 7.

These data were compared with the average statistical data:

100-110% - normal posture;

Less than 90 or more than 125% - severe violation of posture;

90-100% or 110-125% - slight violation of posture.

From Fig. 7 shows that 42% of students have a pronounced violation of posture.

36% - minor postural disorders. Normal posture is found in 22% of tenth graders.

The reason may be that in the lyceum all the desks and chairs are almost the same standard size (Sanitary rules and regulations, 2001).

Rice. 7. State of posture of 10th grade students in %

Chapter 4. Determination of physical activity, risk factors, health level and degree of adaptation to the environment

The physical development and health of students depends on many factors. The attitude of teenagers to their health is of great importance: playing sports, morning exercises, proper nutrition. In order to determine risk factors in the development of morbidity, 10th grade students were offered several tests: “Risk Factors”, “Physical Activity”, “Health” - V.A. Ivanchenko, 1994, P.P. Morev, 1993, V. Mikhailov, A. Palko, 1987 (Appendix 4, Appendix 5, Appendix 6). Test results are in Table 3.

Examination of the posterior chest:

place your thumbs on the chest at the level of the X rib and parallel to it on each side, and with the remaining fingers clasp the chest from the sides; at the same time, placing the hands in this way, move them in the medial direction until skin folds form between the thumbs and the spine. Ask the patient to take a deep breath.

Examination of the anterior chest:

Place your thumbs along the costal arches and your hands on the outer surface of the chest. Move both hands towards each other until a skin fold forms between the thumbs. Ask the patient to take a deep breath. Observe the spread of your thumbs as you inhale, thereby assessing the volume and symmetry of your breathing movements.

The causes of unilateral weakening of the respiratory excursion of the chest or the lag of its half in breathing include chronic diseases of the lungs and pleura, accompanied by the growth of fibrous tissue in them, accumulation of fluid in the pleural cavity, lobar pneumonia, obstruction of a large bronchus on one side, irritation of the pleura on one side.

LUNG PERCUSSION

Percussion helps determine whether the underlying tissues are solid or contain air or fluid, but it allows assessment of the condition of tissues located in the chest at a depth of no more than 5 - 7 cm.

PERCUTORY SOUNDS AND THEIR CHARACTERISTICS

Conditions:

1. Correct symmetrical position of both halves of the chest.

2. Examine by tapping a symmetrical place on both halves of the chest.

3. Position of the patient - sitting or standing.

4. The position of the examiner during percussion is from the front - on the patient’s right hand.

5. The position of the plessimeter should be parallel to the dullness border.

6. The direction of percussion when determining the boundaries of the lungs is from a clear pulmonary sound to a dull one. In front - along the midclavicular line, and from the sides along the mid-axillary line, in the back - along the scapular line.

7. The force of the percussion blow should be weak. Percussion produces the following sounds:

clear- the sound of a healthy lung,

deaf- sound with various shades, from muffled - in places that do not contain air, to absolutely dull (femoral or hepatic dullness) - with effusions,

tympanic - up to box– with emphysema, pneumothorax, over Traube’s space.

TOPOGRAPHIC PERCUSSION

Topographic percussion determines the height of the apexes of the lungs, the width of the Krenig fields and the lower border of the lungs.

Determining the height of the tops start from the front. The plessimeter finger is placed above the clavicle (the terminal phalanx touches the outer edge of the sternocleidopapillary muscle). The finger is moved upward until the percussion sound shortens. Marking the boundary on the side of the finger facing clear sound. Normally, this area is located at a distance of 3 - 4 cm from the middle of the collarbone. Behind Percussion of the apexes is carried out from the crest of the scapula to the VII cervical vertebra.

Determination of the width of the Krenig fields. Krenig's field is a strip of clear percussion tone 4 - 6 cm wide, running from the shoulder to the neck. The pessimeter finger is placed perpendicular to the upper belly of the trapezius muscle - in the middle. From this position, percussion is carried out alternately towards the neck and shoulder until dullness, the border is on the side of the finger facing the clear sound.

Determination of the lower boundaries of the lungs begin on the right along the midclavicular line from top to bottom from a clear sound to a dull sound and stop with the appearance of a shortening of the percussion sound. Marking the boundary on the side of the finger facing the clear percussion sound. In a similar way, the lower border is determined along the mid-axillary lines and along the scapular lines on the right and left.

BOUNDARIES OF LUNG LOBE

Side: All 3 beats are identified on the right, 2 beats on the left.

Determination of mobility of the lower edges of the lungs (lung excursion) carried out along the mid-axillary or posterior axillary lines. Normally, the lower edge of the lung, with intense inhalation, falls 3 - 4 cm below the border; with maximum exhalation, the edge of the lung also rises by 3 - 4 cm. Thus , respiratory excursion of the lungs is 6 - 8 cm.

The mobility of the lower edge of the lungs in young children can be judged during crying or screaming.