胸腔积液移动的生理学和病理生理学临床概述:叙述性综述

L. Ferreiro, M. Toubes, J. Suárez-Antelo, N. Rodríguez-Núñez, Luis Valdés
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引用次数: 0

摘要

在生理条件下,胸膜腔将肺部与胸壁连接起来,并含有少量不断翻动的液体。胸腔积液的量是液体通过胸膜毛细血管进入胸膜与胸膜顶最依赖区域的淋巴管引流之间平衡的结果。液体过滤受斯塔林力控制,由毛细血管和胸膜腔的静水压和气压决定。重吸收率是胸腔积液产生率的 28 倍。当进入胸膜腔的液体量和被重新吸收的液体量之间的平衡被打破时,就会发生胸腔积液。静水压或气压的变化会产生渗出液,但不会对胸膜造成任何结构性损伤。相反,液体流动的紊乱(过滤增加或重吸收减少)则会产生渗出物。因此,细胞过程及其诱发的炎症和免疫反应决定了胸腔积液的成分。了解 PE 的基本病理生理过程,尤其是细胞过程,有助于确定胸腔积液的病因。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical overview of the physiology and pathophysiology of pleural fluid movement: A narrative review
In physiological conditions, the pleural space couples the lung with the chest wall and contains a small amount of fluid in continuous turnover. The volume of pleural fluid is the result from the balance between the entry of fluid through the pleural capillaries and drainage by the lymphatics in the most dependent areas of the parietal pleura. Fluid filtration is governed by Starling forces, determined by the hydrostatic and oncotic pressures of the capillaries and the pleural space. The reabsorption rate is 28 times greater than the rate of pleural fluid production. The mesothelial layer of the inner lining of the pleural space is metabolically active and also plays a role in the production and reabsorption of pleural fluid.Pleural effusion occurs when the balance between the amount of fluid that enters the pleural space and the amount that is reabsorbed is disrupted. Alterations in hydrostatic or oncotic pressure produce a transudate, but they do not cause any structural damage to the pleura. In contrast, disturbances in fluid flow (increased filtration or decreased reabsorption) produce an exudateviaseveral mechanisms that cause damage to pleural layers. Thus, cellular processes and the inflammatory and immune reactions they induce determine the composition of pleural fluid. Understanding the underlying pathophysiological processes of PE, especially cellular processes, can be useful in establishing the etiology of pleural effusion.
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