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Tràn dịch màng phổi
Tràn dịch màng phổi
Tng lng dch trong khoang mng phi (>20ml) Trn dch mng phi chia lm 2 loi : (1) dch thm v (2)
dch tit
Trn dch mng phi l triu chng
(mesothelial )
4. Nhu m phi 5. H thng mch mu trong nhu m phi (M ph qun, M phi)
mng phi vo t cc mao mch vng nh vi mt lng ~250ml/ngy, nhm bi trn 2 l mng phi khi di chuyn trong qu trnh h hp. Ngoi ra, dch mng
tp trung vng nh
Trong mi khoang mng phi c ~ 20ml dch, to ra mt
Protein LDH ng pH
Mao mch phi: suy tim tri Gim p lc keo ti vi mao mch (gim protein mu nh hi chng thn h, suy
dinh dng, x gan)
Gim s dn lu ca mch bch huyt (u phi, TDMP cn vim phi) Thm dch t khoang mng bng qua nhng khe h ca c honh hoc
qua nhng mch bch huyt xuyn c honh (bng bng, thm phn phc mc,
hi chng Meig)
Tng dch trong khoang k phi Tn thng mch mu thnh ngc Tn thng ng ngc
trn dch, khng kh th, vn nm nga, u thp c, nhng c khuynh hng nm nghing v bn lnh trnh au .
Khi lng nc trung bnh, khong 700-800ml ti 1500 ngi
Recommendations of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR). Volume 42, Issue 07, July 2006
DCH THM
C CH
TNG P LC THY TNH GIM P LC KEO
DCH TIT
VIM NHIM
MU SC T BO
T TRNG Protein Protein [DCH] Protein [MU] Albumin LDH LDH [DCH] LDH [MU] Cholesterol
TRONG HNG CU
< 1.012 < 3 g/dL < 0.5 > 1.2 g/dL < 200 UI < 0.6 hoc < < 45 mg/dL
C BCH CU (+++)
> 1.020 > 3 g/dL > 0.5 < 1.2 g/dL > 200 UI > 0.6 hoc > > 45 mg/dL
DCH THM
DCH TIT
Vim mng phi (lao, vi khun, virus, k sinh
trng)
BNH L
Gim protid mu Thm phn phc mc Tc tnh mch ch trn Ph nim Hi chng Meigs
Thuyn tc phi
Chn thng Bnh l Collagen (SLE, RA) Do thuc
Ure mu
Hi chng Dressler (hi chng vim nhim c
tim sau m mng ngoi tim st, au ngc kiu mng phi, trn dch mng tim)
tc kh chu mt bn lng ngc. Nu c au ngc chng t l thnh mng phi b vim hoc b kch thch v gi y l
Hi chng ba gim
Rung thanh gim G c R ro ph nang gim
i th ca dch chc d : lng , mu , trong, qunh ca dch. Xt nghim sinh ho: nh lng m (protein), LDH (lactat
dehydrogenase), glucose, pH
m t bo trong dch mng phi
nghim t bo hc
Hct nu nghi ng trn mu mng phi
Signs
Orthopnea, jvd, or peripheral edema (CHF) Unilateral extremity swelling (PE) Ascites (hepatic hydrothorax or Meigs)
History
Chest trauma (hemothorax) Abdominal surgery (post-op effusion) Post CABG surgery (Dresslers syndrome)
Nu lng dch < 100 ml: khng thy bt thng trn phim
khong 2 lt.
Nu hnh nh x quang m ton b mt bn phi: lng
hoc lng t
CT scan ngc: cho php phn tch hnh nh mng phi, nhu m phi, lp dch
mng phi m xquang thng qui v siu m khng pht hin
Soi ph qun
Ho ra mu
M/t gc sn honh
Khng
X Quang ngc nm nghing, CT ngc hoc siu m ngc B dy dch > 10mm
Khng
Theo di
c
Chc d mng phi chun on
C 1 trong cc tiu chun sau: - m DMP/HT > 0.5% - LTH DMP/HT> 0.6% - LTH DMP >2/3 tr s cao nht ca LDH bnh thng/HT
Khng
Dch thm
c
C kh nng l dch tuyn BN c suy tim sung huyt hoc s gan
Khng
Dch tit
Khng
c
m HT- m DMP> 3.1 g/dL
Tinh cht DMP ng trong DMP Phn tch t bo Cc markers Lao trong DMP.
C mu?
Dch duc?
Khng C
Phn tch sinh ha
Trong
Het > 20 %
C
Trn mu mng phi Xem xt t ng dn lu
Trn dng cht mng phi (chylothorax) hoc gi trn dng cht mng phi (psendochylothorax) Xem cn lng DMP Tinh th cholesterol Gi trn dng cht mng ph
Khng
Tryglycerider DMP 50-100 mg/dL > 100 mg/dL Trn dng cht MP
< 50 mg/dL
khng
chylomicrons
m tnh
Phn tch dch mng phi
T bo hc DMP (cellblock)
Dng tnh
Trn dch mng phi c tnh
Lao
Bnh l MP mn tnh
ADA / y- interferon / sinh thit mng phi / cy tm VT lao CT ngc cn quang
Dng tnh
C
Khc m m
khng
S hoc CT bng
m tnh
m tnh
BN ci thin
iu tr th lao
C
TDMP cn vim phi
khng
CT ngc cn quang
Dng tnh
Bnh l tiu ha
Dng tnh
Thuyn tc phi
khng
Cn nhc ni soi mng phi Xem xeta nhng ca TDMP him nh HC dessler Bnh cao keo Mesothelioma Bnh do nm v KST
C
Theo di
ch chnh l s di chuyn trc tip ca dch mng bng vo khoang mng phi qua nhng l nh ca c honh
TDMP thng bn phi v thng vi lng nhiu c th gy
kh th nng
TDMP t do cn chp phim x quang nm nghing, CT scan lng ngc hoc siu m. Nu lng
dch t do c b dy > 10 mm, cn thc hin chc d mng phi iu tr.
Nu kt qu t bo hc ban u m tnh, khi ni soi mng phi l th thut tt nht nu vn nghi ng nhiu l trn dch c tnh. Khi ni soi mng phi, cn thc hin th thut co xc mng phi gy dnh mng phi. Nu khng c dng c ni soi mng phi, cn thc hin sinh thit mng phi bng kim
dch chng t bnh lan trn v hu ht cc bnh l c tnh khi gy TDMP u khng th cha lnh bng ha tr
Nu bnh nhn c kh th lm nh hng n cht lng cuc sng v nu kh th gim khi chc tho bt dch mng phi, khi cn thc hin mt trong cc th thut sau y: (1) t mt catheter nh lu li, hoc (2) t ng dn lu mng phi v lm dnh mng phi bng cht gy dnh nh doxycycline 500 mg
Mesothelioma
Mesothelioma c tnh l khi u nguyn pht ca t bo trung m mng phi;
X quang ngc cho thy c TDMP, dy mng phi lan ta, v na lng ngc bn trn dch xp xung
TDMP l thuyn tc phi. Kh th l triu chng thng gp nht. Dch mng phi lun l dch tit
Chn on da trn CT scan hoc chp ng mch phi
iu tr cng ging nh iu tr thuyn tc phi. Nu dch mng phi gia tng
sau khi dng khng ng, c l bnh nhn b thuyn tc mi hoc b bin chng khc nh trn mu mng phi hoc nhim trng mng phi
chp bch huyt (lymphangiogram) v CT scan trung tht nh gi cc hch trung tht
Hct > 1/2 ca Hct trong mu l c trn mu mng phi. Hu ht nhng trng hp trn mu mng phi l do chn thng, cc nguyn nhn khc l v mch
mu hoc ung th
Hu ht nhng bnh nhn trn mu mng phi phi c t dn lu mng
phi. Nu trn mu mng phi do rch mng phi, khi hai l mng phi p li