文档介绍：胸腔积液 pleural effusion 大连医科大学附属第一医院消化 wgj 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 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胸腔内负压(5) 胸腔内胶体渗透压(8 cm H 2 O ) 淋巴回流毛细血管胶体渗透压毛细血管静水压 30cm H 2 O 34 cm H 2O 11 cm H 2 O 壁层胸膜脏层胸膜液体渗出压力梯度(5+8+ 30 )- 34 =9 cm H 2 O 液体再吸收压力梯度 34 -( 5+8+ 11 )= 10 cm H 2 O 胸膜腔(体循环 cap ) (进入) (肺循环 cap ) (吸收) ?壁层胸膜液体进入胸膜腔压力梯度: 9cmH 2O ?毛细血管静水压 30cmH 2O ?胸膜腔负压 5cmH 2O ?胸膜腔胶体渗透压 8cmH 2O ?毛细血管胶体渗透压 34cmH 2O ?脏层胸膜液体从胸膜腔回收压力梯度: 10cmH 2O ?毛细血管静水压 11cmH 2O ?胸膜腔负压 5cmH 2O ?胸膜腔胶体渗透压 8cmH 2O ?毛细血管胶体渗透压 34cmH 2O ?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:> 300-500 ml 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 a