文档介绍：第二篇呼吸系统疾病
结核性胸膜炎
(TubercuIous PIeuraI Effus i on)
呼吸内科廉海容
Anatomy： 解剖学： Visceral pleura
Parietal pleura
Latent sp第二篇呼吸系统疾病
结核性胸膜炎
(TubercuIous PIeuraI Effus i on)
呼吸内科廉海容
Anatomy： 解剖学： Visceral pleura
Parietal pleura
Latent space
曰
J胸腔积液转运机制
■既往观点:胸腔液体经胸膜毛细血管的动 脉端滤过，85%从静脉端再吸收，其余 由淋巴系统回流。
■新近观点：胸水转移主要在胸壁毛细血 管、胸壁间质、胸腔内进行；回收： 75%经壁层胸膜上淋巴孔进入淋巴管 （脏层胸膜不参与引流）
g发病机制
■ 1、毛细血管静水压增加
■ 2、血浆胶体渗透压降低
■ 3、毛细血管通透性增加
■ 4、淋巴回流受阻
结核性胸膜炎病因和发病机制
: Mycobacterium tuberculosis 病因：
iscovered by
Acid-fast
in 1882
Pathogenesis : two theories
发病机制：两种学说
Delayed hypersensitive reaction
Pleural infection
0
病理
1. Pleural congestion with cel 1 infiltration, uni lateral in most cases.
胸膜充血，细胞浸润，多数病例累及单侧胸膜
In the early stage, polymorphs predominate.
Typically, lymphocytes predominate.
2. Tuberculous nodules 结核结节
3. Exudative effusion 渗出液
0
临床表现
Symptoms 症状
1. Age, of ten seen in young in elderly people
people, but also
2. Fever, typically 37~ 38°C, but can be >39°C
3. Chest
little
pain, more severe when fluid.
there is only
4. Breathlessness, when there is a lot of fluid.
Physical signs 体征
1. Inspection: ful Iness of chest in the
involved side.
2. Palpation: trachea shifts to the other side, weakness of vocal fremitus .
3. Percussion: dulIness in the
involved side.
4. Auscultation: disappearance of breathing sound
0
实验室和其他检查
X-ray胸片
1. Chest
Fluid is visible only when more than 300
ml.
CT is needed in a few cases.
2. Ultrasonic examination 超声检查
More accurate than X-rays.
Can provide vital inf ormat ion for
thoracentesis.
3. Thoracentesis and fluid examination
essential胸腔穿剌术--诊断的关键
(1)Fluid routine —— exudate
specific gravity > 1. 018;
WBC > 500/cmm, predominated by polymorphs at early stage and lymphocytes later
protein > 3gram/dl
*ADA>45U/L
(2) Acid-fast staining for acid-fast baci11i (not sensitive).
(3) Culture for tuberculous baci11i (time consuming).
(4) Others: culture for bacteria, cytological exam, etc.
4. Pleural