胸腔积等液教案.ppt

本课目录 胸膜腔结构及胸腔积液形成的机制 胸腔积液的临床表现（症状、体征、积液实验室分析、其他检查） 胸腔积液的诊断和鉴别诊断 胸腔积液的治疗 病因和发病机制 What causes Pleurisy？ 毛细血管内静水压增高------漏出液 毛细血管通透性增加 -------渗出液 毛细血管内胶体渗透压降低--漏出液 壁层胸膜淋巴引流障碍------渗出液 损伤 ---------------------血胸/脓胸/乳糜胸 一、影像学检查 包裹性积液 (四)、胸膜活检(pleural biopsy) 经皮胸膜活检对鉴别有无肿瘤及判定胸膜肉芽肿性病变有一定帮助。拟诊结核病时，活检标本除作病理检查外，尚可作结核菌培养 脓胸或有出血倾向者不宜作胸膜活检 三、类肺炎性胸腔积液和脓胸 控制感染 引流 促使肺复张，恢复肺功能 SUMMARY OF PLEURAL EFFUSION There are about 5 to 15ml of pleural fluid, but the rate of turnover of pleural fluid in humans is rapid and may exceed 1 L per day Over exceed volume of pleural fluid is a kind of pathologic condition the hallmarks of pleural disease are pain, ipsilateral restriction of chest wall motion , breathlessness, fever, and an abnormal chest radiograph less than 300ml of pleural fluid is not detected easily except by some special approaches, which are radiograph ultrasound computed tomography thoracentesis the main useful findings are based on pleural fluid analysis, including gross features microscopic appearance chemical analysis (enzymes, tumor immunology, bacteriology rests, cytologic tests) when the initial clinical impression suggests a malignant of tuberculous effusion or if pleural fluid analysis fails to establish the cause of an exudative effusion, pleural biopsy is indicated two types of pleural effusion can be classified, which is transudates and exudates main causes of transudative effusions congestive heart failure nephritic syndrome cirrhosis Meig’s syndrome hydronephrosis peritoneal dialysis Main causes of exudative effusions very common Parapneumonic Malignancy Pulmonary embolism common abdominal diseases Tuberculous Traumatic collagen vascular(rheumatoid and SLE unusal drug-induced Asbestos dressler’s syndrome the treatments of pleural effusion are mainly based on the causes of the disease, and local pleural effusion drainage (五)、支气管镜 (六)、胸腔镜或开胸活检 本课目录 胸膜腔结构及胸腔积液形成的机制 胸腔积液的临床表现（症状、体征、积液实验室分析、其他检查） 胸腔积液的诊断和鉴别诊断 胸腔积液的治疗 诊断与鉴别诊断di