实验诊断学课件：脑脊液浆膜腔积液检查七年制

1、Lab examination of body fluid体液检查体液检查脑脊液检查浆膜腔积液检查痰液检查胃液和十二指肠液检查关节腔积液检查精液检查阴道分泌物检查羊水检查脑脊液检查Cerebrospinal Fluid (CSF) ExaminationOutlineCSF: colourless liquid that flows through the four cerebral ventricles, subarachnoid space and spinal canal surrounding the brain and spinal cord .CSF cirlulation com

2、municate with blood circulationAdult:90150mlNewborn:10 60mlblood brain barrier AIMSInfectionsHemorrhageMalignancyDemyelinationCSFanalysisLumbar puncture (LP)Indications for LP有脑膜刺激症状者。疑有颅内出血者。中枢神经系统恶性肿瘤。脱髓鞘疾病。有剧烈头痛、昏迷、抽搐或瘫痪等症状考虑为神经系统疾患者。中枢神经系统疾患需椎管内给药治疗者。Contradiction for LP病人处于休克、衰竭状态局部皮肤有炎症者。疑有颅内压

3、升高者。脑疝。Collection of CSFcollect 1-2ml in each of three plain tubes1: for microbiology second tube: for chemistry and immunologythird tube: for hematology forth tube: for exfoliative cytologic examination (if necessary)Contents of examinationGeneral Properties：pressure、color、 Transparency 、 Clots and

4、 filmChemical Examination： protein、glucose、chloride Microscopy Bacteriological Examination 一般性状检查General PropertiesPressurePressure Normal Value: Adult(lying): 80180 mmH2O， 40-50 drips/min children：40-100 mmH2O。Increase：Intracranial Inflammation：meningitis, cephalitis, myelitiscerebral edema, cerebr

5、al hemorrhage, brain tumorsExtracranial：hypertension, congestive heart failureDecrease: CSF circulation obstruction, loss or impairment in secretionNormal CSFColor changesColor of CSFConditions or causesMilky With WBC increasePink to yellowWith bloodYellowHyperbilirubinemiaProtein1.5g/LGreen Purulen

6、t CSFBrown to BlackMeningeal melanomaTransparency Normal :Clear, colorlessClear or Cloudy：Viral Meningitis、Epidemic Encephalitis B or Syphilis in CNSGround glass opacity毛玻璃：Tuberculous MeningitisMilky turbid：Purulent Meningitis Clots and filmNormal: No clots or film in 24 hoursPurulent Meningitis :c

7、lots observed in 1-2 hoursTuberculous Meningitis :thin film cover after 1224 hoursSubarachnoid obstruction: yellow jelly化学检查Chemical examinationProtein Qualitative ：Pandy test：-/Quantitative ：0.150.45g/L (adult,lumbar puncture)+Clinical significanceinflammation：PM: (2.5g/L)TM:VM: (0.5)Intracranial t

8、umor, neurosyphilisHypoglycemia：injury of blood brain barrier hyperglycemia: DM病愈后迅速恢复正常早于蛋白、细胞的变换Chloride in CSFAdult ：120130mmol/L TM：，102mmol/LPM：102116mmol/L。Hypochloremia，such as severe vomit、diarrhea, dehydration显微镜检查Microscopic ExaminationNormal ValueRBC：noneWBC:仅少量，淋巴细胞为主，无分叶核细胞。adult：08106/

9、L child：015106/L PURULENT MENINGITIS1000-2000 106/L ，segmented neutrocyte Tuberculous Meningitis 500 106/L，segment neutrocytes in early stage, and lymphocytes increase afterward, plasmocyte also observedViral MeningitisUsually 2.51.5 Glucose mmol/L 2.5-4.550%Chloride mmol/L 120-130 NormalNormalCells

10、 /lNo 1000,neutrocytes Neutrocytes, lymphocytes and plasma cells250,lymphocytes RBC 浆膜腔积液检查Serous Membrane Fluid ExaminationGeneral concepts人体的胸腔、腹腔、心包腔统称为浆膜腔（serous cavity ）General concepts病理情况下，腔内会有较多量的液体，称为浆膜腔积液（serous membrane fluid )按积液存在的不同部位而分别称为胸腔积液 (Pleural fluid) 腹腔积液 (Peritoneal fluid/Asc

11、ites)心包积液(pericardial fluid)浆膜腔积液检查的目的区分积液为漏出液还是渗出液。探寻渗出液的病因。Collectionfour tubesfirst tube: for microbiology second tube: for chemistrythird tube: for routine and hematology (anti-coagulation)forth tube: coagulationClassification Transudate: non-inflammatoryExudate：inflammatoryInfectionTraumaMalign

12、ant tumor各种渗出液血性纤维性乳糜性脓性浆液性胆固醇性一般性状Genenral Properties颜色Transparency Gravityclotting化学检查：Rivalta test 粘蛋白定性试验浆膜在炎症反映的刺激下，分泌粘蛋白，粘蛋白可在醋酸 作用下产生沉淀。漏出液粘蛋白含量少，多为阴性。渗出液多呈阳性。化学检查：葡萄糖测定漏出液与血糖类似渗出液：糖酵解增加，大多葡萄糖含量明显降低化脓性感染最低,常低于1.12mmol/L。Lights Criteria for exudate Fluid/serum TP 0.5Fluid/serum LDH 0.6Fluid LD

13、H 200IU especially for pleural or pericardial fluid其他甘油三酯、胆固醇：乳糜胸Adenosine deaminase: tuberculosisCEA in ascites：malignancy Amylase in ascites: pancreatitis microscopymicroscopymicroscopymicroscopy细胞学检查细胞学检查肿瘤细胞Differential diagnosis of transudate or exudateTransudateExudatecausesIncreased pressureI

14、nfection, malignant cancerAppearanceLight yellow, clear or cloudyBloody, purulent, milky turbidgravity1.018clotting-+Cells100106/L, different cells bacteriology -+ Total protein35g/LRivalta-+Glucose 3.3mmol/L3.3mmol/L*Pleural fluid/serumTP 0.5 *Pleural fluid/serumLDH 0.6 *LDH 200IU *：Light标准渗出液：结核性积

15、液与癌性积液结核性：青年多见，结核菌素试验阳性，积液为草黄色，糖含量较低，淋巴细胞为主，多伴有发热，无其他异常癌性：中年以上，进行性加剧的胸痛，无发热，尤其在大量血性渗出液、抽液后又迅速生长者，要慎重考虑肿瘤的可能。其他检查：胸液脱落细胞及染色体检查胸部影像（X线、CT、MRI）检查、纤维支气管镜检查痰查癌细胞和结核菌病例分析患者A，男，26岁，农民。发热，寒战、头痛3天，意识障碍4小时。3天前因劳累、酒醉后出现发热、寒战、剧烈头痛，4h前开始出现意识障碍，自言自语，不能准确回答问题，并出现抽搐，持续近30min，急诊入院。体检：T 39，P 116次/分，R 25次/分，BP 110/60mmHg。神志不清，昏迷状，检查不合作，瞳孔等大约0.6cm，光反射迟钝，眼底视乳头水肿，颈强直，心肺无