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16. 胸腔积液
概 述
胸膜腔是位于肺和胸壁之间的一个潜在的腔隙。在正常情况下,脏胸膜和壁胸膜表面上有一层很薄的液体,在呼吸运动时起润滑作用。胸膜腔和其中的液体并非处于静止状态,在每一次呼吸周期中胸膜腔形状和压力均有很大的变化,使胸膜腔内液体持续滤出和吸收,并处于动态平衡。任何因素使胸膜腔内液体增加过快或吸收过缓,即产生胸腔积液(pleural effusions)。以下是胸腔积液诊治的临床路径。
表16.1 漏出性胸腔积液
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T16.1_59663.jpg?sign=1739320818-pS2p5di2fPVEiRekbN2Ac351vX7GW1oU-0-577c6326dd0ea26a78ff85fa2f7ff98c)
表16.2 渗出性胸腔积液
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T16.2_13367.jpg?sign=1739320818-HF37jbk1LIU7MkpJ4ppsQyNJlakquHTT-0-ceb80b82ddb166ac3b222525938d2cec)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T16.2_1_13421.jpg?sign=1739320818-WtciGdkYZrvS1Ju5BjwDkyUAZRUngLhJ-0-639f5dc997fc8a22bbff25f92f56e6d1)
表16.3 胸腔积液分析(1)
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T16.3_59985.jpg?sign=1739320818-2HoWGxD9F6gujOZM30i4hZVnTYOhOZkq-0-c6f30c09f50a0eb2df00d031ee7bb93a)
表16.4 胸腔积液分析(2):渗出液的补充检查
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T16.4_59986.jpg?sign=1739320818-6EmnBz3ZRNeeYUBPg0BlzO0lKnD34dQc-0-f0a1695040cd34e4840c0e6cc926f0ad)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T16.4_1_59987.jpg?sign=1739320818-MP0UyKsBBqthir1i98E47WAmdijVqvMC-0-cb6c9dfc5c3aba3aa8a6c01cd53306bb)
表16.5 明确胸腔渗出液的病因进一步检查
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T16.5_59667.jpg?sign=1739320818-ECzE2w08WHmOMbNa1nPOeX3Qw2pEPl2h-0-3be56e8e3af1886e8402911286fd232a)
注:如在可疑恶性肿瘤患者中胸腔积液细胞学为阴性,须在充分引流胸腔积液前行CT检查,因为胸腔积液的存在可提高扫描敏感性