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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=1739500799-oMIs6pcGm0L9QU6IKQpJPSOfeZP5kUWy-0-397a7f50ef2c68cc12f18e68adfb9f92)
表16.2 渗出性胸腔积液
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T16.2_13367.jpg?sign=1739500799-yXWhOf1sTJO549gMLqZeK1QOIGrNADLZ-0-50aed0f821d8ce26f836b7fc6277efea)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T16.2_1_13421.jpg?sign=1739500799-B7udRxfOm48YsiCPiMEuoGlO8zbUUJcD-0-c9a2fc3cf4a2f519d2f119b5d2f71d2f)
表16.3 胸腔积液分析(1)
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T16.3_59985.jpg?sign=1739500799-dxJgfFPjfxLVDouTh3cpFamEaE0J1Qnn-0-aa0048d83704ee04572694bf4dc0c183)
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=1739500799-QtDNevpqYdbSXqWFVejjW2KaBsq0Yanc-0-3a8bd7bd908bcbfb44353ee4f2fd9ddb)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T16.4_1_59987.jpg?sign=1739500799-iN9XtGMGLM0eLz8rxMtMrPl4yTSksAg7-0-61a2fcda29ff6618f98c5f09b58b0497)
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=1739500799-WQwKGOTpFrBWoZETk8zv51CEQsK6sg1Y-0-3e5ded9a0facf01cad9eb3cc658d31ce)
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