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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=1739589499-yvvcKUx3K9xppUGTgFOLTduDUdWm1IzY-0-06196697519d4a7c708067413c2855cb)
表16.2 渗出性胸腔积液
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T16.2_13367.jpg?sign=1739589499-qZQVeiNBM33R6Y0ibpNe0pYjG5c9LUMd-0-7649fe49d070a64294cb19cd6a7d1815)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T16.2_1_13421.jpg?sign=1739589499-41XXuL1Ov3EPTCLiL0DpyM7I7Lwa2FZW-0-1cd2fa83f15f6cd26958d517659ae75d)
表16.3 胸腔积液分析(1)
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T16.3_59985.jpg?sign=1739589499-ex9hiC8MMVxMakjzHARaJgWUDNfUWryr-0-db427683f1eb9cf664afc5b75164ee49)
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=1739589499-Y9bQf8ysas8GWtSG5zZURy7yXG0bt0XV-0-2c6fe989c2d72675a62d7a579cfc58ff)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T16.4_1_59987.jpg?sign=1739589499-ZI2H8OA1yNznTjZozVdQIAtEysleCPs4-0-581422dbab2d479c8060970a573ca5c5)
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=1739589499-0T0U8vClY07YgmnasJNww5a3w18Gazzc-0-dbad1d6651acf9784e18076e54dfcc66)
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