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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=1738927380-FGQwHcebW0iJlByywpUxxEouCXgxVQPM-0-37d230bcbf3993e089406ded675e1dc1)
表16.2 渗出性胸腔积液
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T16.2_13367.jpg?sign=1738927380-A4IuF9KWlSDp0usOlOUy4KgJtIdovxu4-0-08891e4fd7d74c6005eb5785ef410d89)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T16.2_1_13421.jpg?sign=1738927380-CabO23a0efeVQQvFh0KTVlGQDD3GTVhd-0-2a87f22fb1d3a5ff4d34948df8c5ca70)
表16.3 胸腔积液分析(1)
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T16.3_59985.jpg?sign=1738927380-RLgY3e2OoOvUjBXbfRJ259q1s7kM7hXP-0-b185657bf14b4a21e2e6d4482342b005)
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=1738927380-bZgbfGhUpvzPM75WknWjRcHwBGwUttkw-0-0b2a68c23beb04f40b74f242ea9ebd00)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T16.4_1_59987.jpg?sign=1738927380-sqJrM4kKabZ5Qil1NgXvdlbGOEMeYDmb-0-7fee4cd4a66b38f864b8d471116424d0)
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=1738927380-b3uP9pG1PaUPYd7HXwNV7lBOpbAbOy7H-0-a6fe9d37ec4ebcf13c015fe6bd9ee0ee)
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