胸腔积液汇.pptVIP

胸腔积液 pleural effusion Definition 正常胸腔内有微量液体起润滑作用。其产生与吸收处于动态平衡。 当产生增加或吸收减少，胸膜腔内液体积聚，便形成胸腔积液。 General Considerations: Pleural fluid is formed in the normal individual mostly on the parietal pleural surface at the rate of about 0.1mL/kg body weight/h. Absorption of fluid occurs mostly through visceral pleural capillaries, while protein is recovered through parietal pleural lymphatics. The resultant homeostasis leaves 5-15mL of fluid normally present in the pleural space. The five major types of pleural effusion are transudates, exudates, empyema, hemorrhagic pleural effusion or hemothorax, and or chyliform effusion. 胸腔积液产生与吸收的机制 壁层胸膜液体进入胸膜腔压力梯度：9cmH2O 毛细血管静水压 30cmH2O 胸膜腔负压 5cmH2O 胸膜腔胶体渗透压 8cmH2O 毛细血管胶体渗透压34cmH2O 脏层胸膜液体从胸膜腔回收压力梯度：10cmH2O 毛细血管静水压 11cmH2O 胸膜腔负压 5cmH2O 胸膜腔胶体渗透压 8cmH2O 毛细血管胶体渗透压34cmH2O 淋巴回流。 胸腔积液的形成： 上述胸液滤出和再吸收压力梯度失衡或胸膜面积变化 淋巴管引流受影响 【Pathogenesy】 一、毛细血管静水压增高：充血性心衰、缩窄性心包炎等→体循环或肺循环静水压增加。漏出液为主 二、毛细血管通透性增加：胸膜炎症、胸膜肿瘤、全身性疾病等。渗出液（胸水胶渗压升高） 三、血浆胶体渗透压降低：低蛋白血症：肝硬化、肾病综合征。漏出液 四、淋巴管引流障碍：癌症淋巴管阻塞。渗出液 五、损伤所致胸腔内出血：外伤，主A瘤破裂；血性、脓性、乳糜性均属渗出液。 主要病因和积液性质： 参见讲义 P144 表2－13－1 Essentials of Diagnosis Asymptomatic in many cases; pleurtic chest pain if pleuritis is present; dyspnea if effusion is large. Decreased tactile fremitus; dullness to percussion; distant breath sounds; egophony if effusion is large. Radiographic evidence of pleural effusion. Diagnostic findings on thoracentesis. 【Clinical Manifestation】 症状 胸痛：大量积液时，气急加重，胸痛消失。 Pleuritic chest pain and dry cough 呼吸困难：＞300-500ml Small pleural effusions are usually asymptomatic, whereas large pleural effusions may cause dyspnea 体征（1）： 气管移位：大量胸水可伴气管、纵隔移向健侧。 呼吸动度减弱 叩浊音， 呼吸音降低，胸膜摩擦音。 体征（2） Physical findings are absent if less than 200-300mL of pleural fluid is present. Signs consistent with a larger pleural effusion include decrease in tactile fremitus, dullness to percussion, and diminution of breath sounds over the effusion. 原发病的症状、体征： 结核中毒症状，