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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=1739128074-Jb9UHWfLrR2900suv19Ju6bOKYCH0246-0-22e211173374efa38b223d52e83fad24)
表16.2 渗出性胸腔积液
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T16.2_13367.jpg?sign=1739128074-KWaQvEpbFRQOHzrlB0MbMTQjGLifuq3J-0-73199475bcb5bea944b272433dc102e2)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T16.2_1_13421.jpg?sign=1739128074-yksvIWqYI0u2G9ZsNKd5CmmHX8few55t-0-29380fab8bc816f419104fc701221d69)
表16.3 胸腔积液分析(1)
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T16.3_59985.jpg?sign=1739128074-H8uVSLwTim934UGIIOdMhihnGiZLidwP-0-5184958aba75e8f47d0b51e4cef32d47)
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=1739128074-5C4ymRTOXLR4Qv4xNXzuPkS6CTVf7qjN-0-0f05e47d8c78e123d658826ae8b7f85d)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T16.4_1_59987.jpg?sign=1739128074-sPsGm1K184RT8X8UK5KtwlrP2TYfSon4-0-fc7306dd92b4ed3d58a84fc98f02cef7)
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=1739128074-ib8SFeM0YDxGsEzhHMG2fLYFAbXoiHnJ-0-0ed576cb70eca00c1734a9ce4917c585)
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