胸腔积液总论课件.pptxVIP

胸腔积液总论ppt课件胸膜腔功能减少肺与胸壁的摩擦肺的机械保护和支持负压调节心肺功能肺内水肿液的吸收(高静水压高渗透压性肺水肿的25%由胸膜吸收)胸膜腔两层胸膜并不相互接触脏层胸膜无神经纤维胸腔积液量0.3～0.5L时，X线仅见肋膈角变钝；少于0.3L时症状多不明显；若超过0.5L，患者渐感胸闷。胸腔积液与吸收的机制机制34胸液循环与有关压力（cmH2O）关系示意图病因学一、胸膜毛细血管内静水压增高充血性心力衰竭缩窄性心包炎血容量增加上腔静脉或奇静脉受阻二、胸膜毛细血管通透性增加胸膜炎症（结核病、肺炎）结缔组织病（SLE、类风湿关节炎）胸膜肿瘤（恶性肿瘤转移、间皮瘤）肺梗死膈下炎症（膈下脓肿、肝脓肿、胰腺炎）三、胸膜毛细血管内胶体渗透压降低低蛋白血症肝硬化肾病综合征、急性肾小球肾炎粘液性水肿四、壁层胸膜淋巴引流障碍癌症淋巴管阻塞发育性淋巴管引流异常五、损伤所致胸腔内出血主动脉瘤破裂食管破裂胸导管破裂等产生血胸、脓胸、乳糜胸病因恶性45CHF12感染22结核 10细菌 9病毒 1真菌 1脓胸1寄生虫 1肺栓3肝变2胶原1其它5Frequency In the USPleural effusion affects 1.3 million individuals each year congestive heart failure, 500,000;bacterial pneumonia, 300,000 (uncomplicated, 270,000;complicated, 30,000);malignancy, 200,000pulmonary embolus, 150,000; cirrhosis with ascites, 50,000 pancreatitis, 20,000collagen vascular disease, 6,000 and tuberculosis, 2,500.Transudative pleural effusionCongestive heart failure (most common transudative effusion)Hepatic cirrhosis with and without ascites Nephrotic syndromePeritoneal dialysis/continuous ambulatory peritoneal dialysisHypoproteinemia (eg, severe starvation) GlomerulonephritisSuperior vena cava obstruction Fontan procedureUrinothoraxExudative pleural effusionMalignant disorders - Metastatic disease to the pleura or lungs, primary lung cancer, mesothelioma, Kaposi sarcoma, lymphoma, leukemiaInfectious diseases - Bacterial, fungal, parasitic, and viral infections; infection with atypical organisms such as Mycoplasma, Rickettsiae, Chlamydia, LegionellaGI diseases and conditions - Pancreatic disease (acute or chronic disease, pseudocyst, pancreatic abscess), Whipple disease, intraabdominal abscess (eg, subphrenic, intrasplenic, intrahepatic), esophageal perforation (spontaneous/iatrogenic), abdominal surgery, diaphragmatic hernia, endoscopic variceal sclerotherapyCollagen vascular diseases - Rheumatoid arthritis, systemic lupus erythematosus, drug-induced lupus syndrome (procainamide, hydralazine, quinidine, isoniazid, phenytoin, tetracycline, penicillin, chlorpromazine), immunoblast