Pleural effusion examination

The serosal cavity of the human body has pleural cavity, pericardial cavity, peritoneal cavity, joint cavity, scrotal sheath cavity and the like. Under normal conditions, there is only a small amount of liquid in the cavity, which acts as a slip. However, under pathological conditions, there may be a large amount of fluid in the cavity, called serosal effusion, such as pleural effusion, ascites, pericardial effusion, scrotal hydrocele, and joint cavity effusion. Due to the different causes of effusion, it can be divided into two types: leakage liquid and exudate. The various components and properties are obviously different. Check the amount, appearance, pH, relative density, protein, glucose and microscopy of various effusions. The significance lies in the difference in the nature of the effusion, whether it is leakage or exudate, and then find out the cause and conduct diagnosis and treatment. Basic Information Specialist classification: Respiratory examination classification: chest and ascites examination Applicable gender: whether men and women apply fasting: not fasting Tips: The doctor should perform the puncture and extraction at the effusion site under aseptic conditions. The specimen should be sent immediately for examination. Otherwise, heparin or EDTA-Na2 should be added for anticoagulation and stored in the refrigerator. Normal value 1 ~ 20ml. Clinical significance (1) Number of cells in pleural effusion 1 When the number of red blood cell red blood cells is 0.005×10 12 /L (0.5 million/mm 3 ) or less, there is no clinical significance, and 0.01×10 12 /L (10,000/mm 3 ) or more is meaningful. Gross blood pleural effusion shows malignant tumor, traumatic blood pneumothorax, pulmonary infarction, pleural tuberculosis and so on. The hematocrit (Ht) in the bloody pleural effusion is more than 50% of the peripheral blood. 2 The increase of leukocyte neutrophils indicates that the acute inflammation from the lung parenchyma to the thoracic cavity develops into empyema. When a small lymphocyte accounts for more than 50%, it shows a malignant tumor or tuberculosis. Parasitic or fungal pleurisy, or sequelae of blood pneumothorax, increased eosinophils, the cause is unknown. 3 mesothelial mesothelial cells usually account for more than 5% of the cells in the pleural effusion, but tuberculous pleurisy is often less than 1%. (2) bacteriological examination of pleural effusion In recent years, the anaerobic bacteria of the pathogenic bacteria of the empyema have increased, and the Gram-positive cocci are Staphylococcus aureus and Streptococcus. Gram-negative bacilli are Pseudomonas aeruginosa and E. Mycobacterium tuberculosis culture is about 25% positive in tuberculous pleurisy. (3) Biochemical examination of pleural effusion 1 specific gravity of 1.018, protein of 30g / L (3.0g / dl) helps the identification of leakage and exudate. 2 Protein is a necessary test for the identification of leakage and exudate, but protein has no correlation with disease. The protein classification of pleural effusion is the same as serum, the albumin with small molecular weight is relatively increased, and the immunoglobulin (IgG, IgM, IgA) of pleural effusion is lower than the serum value, and there is no diagnostic significance. Paragonimiasis (Pneumocystis) The pleural effusion IgE value of the disease is higher than the serum and its diagnostic value is greater. 3 The glucose concentration in glucose pleural effusion changes in parallel with the serum glucose concentration. The glucose concentration in pleural fluid is lower than 3.33mmol/L (60mg/dl). It is found in tuberculosis, cancerous pleurisy, rheumatoid arthritis, pneumonia complicated with pleurisy. Wait. The concentration of glucose in systemic lupus erythematosus (SLE) pleural effusion is in the normal range and is useful for the identification of rheumatoid arthritis. 4 Lactate dehydrogenase (LDH) is a necessary examination for the identification of leakage and exudate. The degree of inflammation of the pleura is generally parallel to the LDH value of pleural effusion. The LDH isoenzyme of exudative pleural effusion is usually high in type 4 and type 5, and about 1/3 of cancerous pleurisy is high in type 2. 5 amylase pleural effusion amylase concentration in the serum limit of the normal limit is more common in pancreatitis, cancer pleurisy, esophageal rupture three diseases. 6 pH pleural effusion pH <7.20 is more common in pneumonia complicated by pleurisy, esophageal rupture, rheumatoid arthritis, tuberculous pleurisy, cancerous pleurisy, hemothorax, systemic lupus erythematosus. 7 Adenosine dehydrogenase (ADA) tuberculous pleurisy auxiliary diagnosis, ADA> 50U / L is mostly tuberculosis, hemolysis of cancerous pleural effusion also appeared in high values, must be identified. 8 The increase of triglyceride neutral fat in pleural effusion is greater than 4.52mmmol/L, while cholesterol contains normal chylothorax. (4) Cancer cell examination The item that must be examined for the diagnosis of cancerous pleurisy, the positive rate of cancer cell diagnosis is 30-70%, and the negative does not completely deny the cancerous pleural effusion. Precautions 1. Regularly perform platelet measurement, clotting time, and stereo X-ray chest X-ray before pumping. 2. Select the puncture site according to the chest signs, X-ray, CT or B-ultrasound results. 3. Do a good job of explaining and explaining the work of the patient, and contact with concerns; for those who are nervous, they can give 10mg of diazepam or a static pain of 0.03g of codeine half an hour before surgery. 4. Prepare all kinds of instruments, medicines and tubes needed for the operation, and prepare the drainage tube for chest drainage. 5. The patient's reaction should be closely observed during the operation, such as dizziness, pale, sweating, palpitations, chest pressure or severe pain, fainting and other pleural reactions; or continuous cough, shortness of breath, cough foaming, etc. Immediately stop the pumping and subcutaneously inject 0.1% adrenaline from 0.3 to 0.5 ml. Or other symptomatic treatment. 6. A single pumping should not be too much, too fast, diagnostic liquid 50 ~ 100ml can be; decompression liquid, the first time does not exceed 600ml, after each time does not exceed 1000ml; such as empyema, try to pump each time net. 7. Strict aseptic operation, to prevent air from entering the chest during operation, and always maintain negative pressure in the chest. 8. Puncture below the 9th intercostal space should be avoided to avoid penetrating the diaphragm and damaging the abdominal organs. 9. The doctor should perform the puncture and extraction at the effusion site under aseptic conditions. The specimen should be sent immediately. Otherwise, heparin or EDTA-Na2 should be added for anticoagulation and stored in the refrigerator. When suspected of purulent infection, use sterile tubes to retain specimens according to regulations; when sending tumor cells, at least 100ml of pleural fluid should be taken, and should be sent immediately to avoid autolysis of cells and affect the results. Inspection process The doctor will perform the examination immediately after the puncture and extraction at the effusion site under sterile conditions. The detection methods are microscopic examination and biochemical method. Not suitable for the crowd Contraindications: Healthy people. Adverse reactions and risks 1. Infection: Pay attention to aseptic operation when puncture, pay attention to local cleaning after puncture, prevent water pollution and avoid infection. 2, bleeding: puncture needle damage to local blood vessels or tissue caused by local bleeding, should try to avoid puncture too deep.