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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=1738854133-iLP10YBusLjqbHWFiRqJUNbp4p6I1LrU-0-1dde3f97eb0e5d2de2bad34ab926e89c)
表16.2 渗出性胸腔积液
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T16.2_13367.jpg?sign=1738854133-IeB9TeU9gJKIbJFbirnbIWnvPzXgsprz-0-4091136176dc3de1f5922f7b0e1f3126)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T16.2_1_13421.jpg?sign=1738854133-2A9EW57buBfyhqxk7COWmXifpCmxqztw-0-b4613bbc7d2eea8a1981f50d40f5cddf)
表16.3 胸腔积液分析(1)
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T16.3_59985.jpg?sign=1738854133-wa00wOwGVKHL0Pq0CO4r8JSB1GlGktWP-0-dd7248f34e09432013c88ca51ee43f52)
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=1738854133-BOkYor5gmEo3ApvipiC5xbRI7Af32fzU-0-2ae3411acd325b5cfe1f7c4b1bb77144)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T16.4_1_59987.jpg?sign=1738854133-CxNQIrfGuY0VOt5HLq65KFhWCMZ66fEn-0-0f8068b5c089810543ed005740012381)
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=1738854133-6X23ZID8NYuji7IvRZKb60l8jJ3bWM45-0-868e7e81d058d59e1171d38fa5630228)
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