小動物疾病系統

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肋膜積液
作者
林言品、賴政宏、鄭豐邦
中文病名 肋膜積液
英文病名 Pleural Effusion
疾病描述

 病因:

    肺臟位於胸腔之兩側,正常時如同氣球一般,脹滿胸腔及其空間。肺臟由兩層肋膜所包覆,其與胸壁間有一空間,稱之為肋膜腔。在正常情況時,兩層肋膜為緊密相鄰,其間只有少許液體的存在,此液體在肺臟進行擴張或是收縮時有潤滑的功能,但當此液體的數值超過正常範圍時,會使得肋膜腔的壓力上升,如此便會擠壓肺臟之空間,發生此狀況時我們稱為肋膜積液。

    可能會導致肋膜積液的原因包含:心臟衰竭、血液中的白蛋白過低、惡性腫瘤轉移、肺部感染(如肺炎、肺結核、膿胸)、淋巴系統功能損傷時淋巴回流受阻等等原因。

臨床症狀:

    呼吸困難、乾咳、發燒(感染時)、動物呼吸時有不適感

診斷方法
  1. 胸部X光檢查
  2. 胸腔超音波檢查
  3. 胸部電腦斷層掃描
治療方法

1. 氧氣治療。

2. 胸腔穿刺放液術。

3. 肋膜沾黏術。

4. 出現此情形時須停止輸液,並且考慮使用利尿劑。

預防控制方法

1. 避免寵物進行激烈活動。

2. 若動物出現呼吸困難的情況,可以配合使用氧氣以改善症狀。

3. 若動物有呼吸疼痛的情況,經獸醫師評估後可開立止痛藥,以舒緩不適。

4. 在進行胸腔穿刺放液術後,須注意傷口是否有異常(持續出現滲出一、穿刺傷口出現紅、腫、熱、痛等炎症反應)。

相關圖片 <p class="MsoNormal"><span lang="EN-US" style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">&nbsp; &nbsp; &nbsp;</span><span lang="EN-US" style="mso-bidi-font-size:
12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">&nbsp;&nbsp;&nbsp;&nbsp;(</span><span lang="EN-US" style="mso-bidi-font-size:12.0pt;font-family:標楷體">Hedlund et al., 2007</span><span lang="EN-US" style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">)</span><span lang="EN-US" style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;
mso-hansi-font-family:&quot;Times New Roman&quot;">圖一:此為肋膜積液犬隻側躺胸腔照之放射線圖象。於患犬沿胸骨之腹側有出現扇貝形影像。</span><span lang="EN-US" style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;mso-fareast-font-family:
標楷體"><o:p></o:p></span></p>
Close<p class="MsoNormal"><span lang="EN-US" style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">&nbsp; &nbsp; &nbsp;</span><span lang="EN-US" style="mso-bidi-font-size:
12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">&nbsp;&nbsp;&nbsp;&nbsp;(</span><span lang="EN-US" style="mso-bidi-font-size:12.0pt;font-family:標楷體">Hedlund et al., 2007</span><span lang="EN-US" style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">)</span><span lang="EN-US" style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;
mso-hansi-font-family:&quot;Times New Roman&quot;">圖一:此為肋膜積液犬隻側躺胸腔照之放射線圖象。於患犬沿胸骨之腹側有出現扇貝形影像。</span><span lang="EN-US" style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;mso-fareast-font-family:
標楷體"><o:p></o:p></span></p>

<p class="MsoNormal"><span lang="EN-US" style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">&nbsp; &nbsp; &nbsp;</span><span lang="EN-US" style="mso-bidi-font-size: 12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">&nbsp;&nbsp;&nbsp;&nbsp;(</span><span lang="EN-US" style="mso-bidi-font-size:12.0pt;font-family:標楷體">Hedlund et al., 2007</span><span lang="EN-US" style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">)</span><span lang="EN-US" style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;"><o:p></o:p></span></p> <p class="MsoNormal"><span style="font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;; mso-hansi-font-family:&quot;Times New Roman&quot;">圖一:此為肋膜積液犬隻側躺胸腔照之放射線圖象。於患犬沿胸骨之腹側有出現扇貝形影像。</span><span lang="EN-US" style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;mso-fareast-font-family: 標楷體"><o:p></o:p></span></p>


<p>&nbsp;<span lang="EN-US" style="font-family: 'Times New Roman', serif;">(</span><span lang="EN-US" style="font-family: 標楷體;">Richard <i>et al</i>., 2014</span><span lang="EN-US" style="font-family: 'Times New Roman', serif;">)</span></p>
<p class="MsoNormal"><span style="mso-bidi-font-size:12.0pt;font-family:標楷體;
mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:&quot;Times New Roman&quot;">圖二:</span><span style="font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:
&quot;Times New Roman&quot;">此為貓之胸腔放射線圖象。肺臟位於蓄積液體的頂部,取代氣管之背側,並且造成縱膈團塊或是心臟擴大等錯覺。</span><span lang="EN-US" style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;mso-fareast-font-family:
標楷體"><o:p></o:p></span></p>
Close<p>&nbsp;<span lang="EN-US" style="font-family: 'Times New Roman', serif;">(</span><span lang="EN-US" style="font-family: 標楷體;">Richard <i>et al</i>., 2014</span><span lang="EN-US" style="font-family: 'Times New Roman', serif;">)</span></p>
<p class="MsoNormal"><span style="mso-bidi-font-size:12.0pt;font-family:標楷體;
mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:&quot;Times New Roman&quot;">圖二:</span><span style="font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:
&quot;Times New Roman&quot;">此為貓之胸腔放射線圖象。肺臟位於蓄積液體的頂部,取代氣管之背側,並且造成縱膈團塊或是心臟擴大等錯覺。</span><span lang="EN-US" style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;mso-fareast-font-family:
標楷體"><o:p></o:p></span></p>

<p>&nbsp;<span lang="EN-US" style="font-family: 'Times New Roman', serif;">(</span><span lang="EN-US" style="font-family: 標楷體;">Richard <i>et al</i>., 2014</span><span lang="EN-US" style="font-family: 'Times New Roman', serif;">)</span></p> <p class="MsoNormal"><span style="mso-bidi-font-size:12.0pt;font-family:標楷體; mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:&quot;Times New Roman&quot;">圖二:</span><span style="font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family: &quot;Times New Roman&quot;">此為貓之胸腔放射線圖象。肺臟位於蓄積液體的頂部,取代氣管之背側,並且造成縱膈團塊或是心臟擴大等錯覺。</span><span lang="EN-US" style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;mso-fareast-font-family: 標楷體"><o:p></o:p></span></p>


<p>&nbsp;<span lang="EN-US" style="text-indent: 48pt; font-family: 'Times New Roman', serif;">(</span><span lang="EN-US" style="text-indent: 48pt; font-family: 標楷體;">Hedlund <i>et al</i>., 2007</span><span lang="EN-US" style="text-indent: 48pt; font-family: 'Times New Roman', serif;">)</span><br />
<span style="font-size:12.0pt;font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;
mso-hansi-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family:&quot;Times New Roman&quot;;
mso-font-kerning:1.0pt;mso-ansi-language:EN-US;mso-fareast-language:ZH-TW;
mso-bidi-language:AR-SA">圖三:此為胸腔分離橫向斷層掃描影像。患犬為五歲齡之德國短毛犬,於左後肺葉有膿瘍</span><span lang="EN-US" style="font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;
mso-fareast-font-family:標楷體;mso-font-kerning:1.0pt;mso-ansi-language:EN-US;
mso-fareast-language:ZH-TW;mso-bidi-language:AR-SA"> (</span><span style="font-size:12.0pt;font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;
mso-hansi-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family:&quot;Times New Roman&quot;;
mso-font-kerning:1.0pt;mso-ansi-language:EN-US;mso-fareast-language:ZH-TW;
mso-bidi-language:AR-SA">箭頭指向處</span><span lang="EN-US" style="font-size:12.0pt;
font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;mso-fareast-font-family:標楷體;mso-font-kerning:
1.0pt;mso-ansi-language:EN-US;mso-fareast-language:ZH-TW;mso-bidi-language:
AR-SA">)</span><span style="font-size:12.0pt;font-family:標楷體;mso-ascii-font-family:
&quot;Times New Roman&quot;;mso-hansi-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family:
&quot;Times New Roman&quot;;mso-font-kerning:1.0pt;mso-ansi-language:EN-US;mso-fareast-language:
ZH-TW;mso-bidi-language:AR-SA">,並且有嚴重的氣胸及肋膜積液。</span></p>
Close<p>&nbsp;<span lang="EN-US" style="text-indent: 48pt; font-family: 'Times New Roman', serif;">(</span><span lang="EN-US" style="text-indent: 48pt; font-family: 標楷體;">Hedlund <i>et al</i>., 2007</span><span lang="EN-US" style="text-indent: 48pt; font-family: 'Times New Roman', serif;">)</span><br />
<span style="font-size:12.0pt;font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;
mso-hansi-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family:&quot;Times New Roman&quot;;
mso-font-kerning:1.0pt;mso-ansi-language:EN-US;mso-fareast-language:ZH-TW;
mso-bidi-language:AR-SA">圖三:此為胸腔分離橫向斷層掃描影像。患犬為五歲齡之德國短毛犬,於左後肺葉有膿瘍</span><span lang="EN-US" style="font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;
mso-fareast-font-family:標楷體;mso-font-kerning:1.0pt;mso-ansi-language:EN-US;
mso-fareast-language:ZH-TW;mso-bidi-language:AR-SA"> (</span><span style="font-size:12.0pt;font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;
mso-hansi-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family:&quot;Times New Roman&quot;;
mso-font-kerning:1.0pt;mso-ansi-language:EN-US;mso-fareast-language:ZH-TW;
mso-bidi-language:AR-SA">箭頭指向處</span><span lang="EN-US" style="font-size:12.0pt;
font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;mso-fareast-font-family:標楷體;mso-font-kerning:
1.0pt;mso-ansi-language:EN-US;mso-fareast-language:ZH-TW;mso-bidi-language:
AR-SA">)</span><span style="font-size:12.0pt;font-family:標楷體;mso-ascii-font-family:
&quot;Times New Roman&quot;;mso-hansi-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family:
&quot;Times New Roman&quot;;mso-font-kerning:1.0pt;mso-ansi-language:EN-US;mso-fareast-language:
ZH-TW;mso-bidi-language:AR-SA">,並且有嚴重的氣胸及肋膜積液。</span></p>

<p>&nbsp;<span lang="EN-US" style="text-indent: 48pt; font-family: 'Times New Roman', serif;">(</span><span lang="EN-US" style="text-indent: 48pt; font-family: 標楷體;">Hedlund <i>et al</i>., 2007</span><span lang="EN-US" style="text-indent: 48pt; font-family: 'Times New Roman', serif;">)</span><br /> <span style="font-size:12.0pt;font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;; mso-hansi-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family:&quot;Times New Roman&quot;; mso-font-kerning:1.0pt;mso-ansi-language:EN-US;mso-fareast-language:ZH-TW; mso-bidi-language:AR-SA">圖三:此為胸腔分離橫向斷層掃描影像。患犬為五歲齡之德國短毛犬,於左後肺葉有膿瘍</span><span lang="EN-US" style="font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;; mso-fareast-font-family:標楷體;mso-font-kerning:1.0pt;mso-ansi-language:EN-US; mso-fareast-language:ZH-TW;mso-bidi-language:AR-SA"> (</span><span style="font-size:12.0pt;font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;; mso-hansi-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family:&quot;Times New Roman&quot;; mso-font-kerning:1.0pt;mso-ansi-language:EN-US;mso-fareast-language:ZH-TW; mso-bidi-language:AR-SA">箭頭指向處</span><span lang="EN-US" style="font-size:12.0pt; font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;mso-fareast-font-family:標楷體;mso-font-kerning: 1.0pt;mso-ansi-language:EN-US;mso-fareast-language:ZH-TW;mso-bidi-language: AR-SA">)</span><span style="font-size:12.0pt;font-family:標楷體;mso-ascii-font-family: &quot;Times New Roman&quot;;mso-hansi-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family: &quot;Times New Roman&quot;;mso-font-kerning:1.0pt;mso-ansi-language:EN-US;mso-fareast-language: ZH-TW;mso-bidi-language:AR-SA">,並且有嚴重的氣胸及肋膜積液。</span></p>


參考文獻

 1.      McGrath E, Anderson P. Diagnosis of pleural effusion: a systematic approach. American Journal of Critical Care, 2011; 20: 119-128.

2.      Musani AI. Treatment options for malignant pleural effusion. Current Opinion in Pulmonary Medicine, 2009; 15: 380-387.

3.      Harold D, Tracey J, Anthony J, Pamela K, Robert M, Renee R, Heidi S. Fluid therapy guidenlines for dogs and cats. Veterinary practice guideline, 2013; 49: 149-159.

4.      Hedlund CS, Johnson AL, Schulz KS, Seim HB, Willard MD. Small animal surgery 3rd, 2007: 1015.

5.      Hedlund CS, Johnson AL, Schulz KS, Seim HB, Willard MD. Small animal surgery 3rd, 2007: 979.

6.      Richard WN, Couto CG. Small animal internal medicine 5th, 2014: 344.

Richard WN, Couto CG. Small animal internal medicine 5th, 2014: 337-345.

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