心包积液
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临床上可无症状，但如果液体积聚导致心包腔内压升 高而产生心脏压迫则可出现心脏压塞。
Pericardial Effusion
The development of increased intrapericardial pressure secondary to pericardial effusion depends on several factors: ①The absolute volume of the effusion, ②The rate of fluid accumulation, and The ③The physical characteristics of the pericardium itself.
如液体迅速增加超过150-200ml，则心包腔内压会显著 上升。
Pericardial Effusion Without Cardiac Compression(不伴心脏压塞的心包积液 不伴心脏压塞的心包积液) 不伴心脏压塞的心包积液
History(病史 . 病史) 病史 Patients who develop pericardial effusion without elevation of intrapericardial pressure may have no symptoms whatsoever.
肺受压及随后出现的肺不张导致呼吸困难，膈神经受 压导致呃逆，或喉返神经受压致声嘶，邻近的腹腔脏 器受压可以产生恶心和腹胀感。
History
Nausea and a sense of abdominal fullness may be present from pressure on adjacent abdominal viscera.
二维超声心动图是目前区别全心包积液和包裹性心包 积液的金标准。
Management
The clinical significance of any pericardial effusion depends on (1) the presence or absence of hemodynamic embarrassment due to increased intrapericardial pressure and (2) the presence and nature of the und-erlying systemic disease.
Chest Roentgenogram( X线胸片) 线胸片)
Enlargement of the cardiac silhouette usually does not occur until at least 250 ml of fluid have accumulated in the pericardial space.
心包积液可出现于所有急性心包炎中，为壁层心包受 损的反应。
Pericardial Effusion
It may be clinically silent, but if the accumulation of fluid causes intrapericardial pressure to increase,resulting in cardiac compression,the symptoms of cardiac tamponade develop.
不伴心包腔内压升高的小量心包积液不产生特殊的体 征，而大量积液可产生一些特征性的体征。
Physical Examination
The heard sounds may be muffled owing to the interposition of fluid between the chest wall and the cardiac chambers.
心包腔内液体积聚时，心电图表现为非特异性的QRS 电压降低和T波低平，
Electrocardiogram
Electrical alternans suggests the presence of massive pericardial effusion and cardiac tampotion
A small pericardial effusion in the absence of an increase in intrapericardial pressure may result in no specific physical findings, whereas a large effusion may produce several characteristic physical findings.
中等到大量积液时可出现明显的心脏摆动呈假性二尖 瓣脱垂和室间隔前向运动。
Echocardiogram
Two-dimensional echocardiography is now the gold standard for identifying circumferential pericardial effusions and in identifying a loculated pericardial effusion.
History
Large pericardial effusions may cause symptoms by mechanical compression of adjacent structures, including dysphagia from esophageal compression, cough due to bronchial/tracheal compression,
很少量心包积液只有在收缩期后心包处见到心包与心 外膜间的回声分开。
Echocardiogram
Moderate to large effusions may be associated with excessive swinging motion of the heart and the false-positive appearance of mitral valve prolapse and anterior septal motion.
心包积液压迫左肺底产生Ewart征，即左肩胛角下的一 片听诊浊音区。由于肺实质受压在肺野内可闻及罗音。
Physical Examination
Rales may be heard over the lung fields secondary to compression of lung parenchyma.
PERICARDIAL EFFUSION
(心包积液)
Pericardial Effusion
Pericardial effusion may develop as a response to injury of the parietal( 壁 层 的 ) pericardium with all cases of acute pericarditis.
正常人心包腔容纳15-50ml液体，如液体积聚缓慢， 心包伸展，心包腔内可适应多达2升液体而不出现心 包腔内压升高。
Pericardial Effusion
If additional fluid is rapidly added to a volume exceeding about 150 to 200 ml, a marked rise of intrapericardial pressure occurs.
继发于心包积液的心包腔内压升高与以下几个因素 有关：①绝对的积液量；②积液产生的速度；③心 包本身的特性。
Pericardial Effusion
The pericardical space in humans normally contains between 15 and 50 ml of fluid.If additional fluid accumulates slowly, the pericardium stretches; the pericardial sac can accommodate up to 2 liters without elevation of intrapericardial pressure.
一些病例中心脏可类似球形或烧瓶性，左心缘模糊且 将肺门血管影遮掩。包裹性积液可呈现囊状表现。
Electrocardiogram
The electrocardiogram may reveal the nonspecific findings of a reduction in QRS voltage and flattening of the T waves as a fluid accumulates within the pericardial space.
有心包积液但没有心包腔内压升高的患者可以没有任 何症状。
History
Occasionally these patients complain of a constant oppressive dull ache or pressure in the chest.
偶尔这些病人会主诉有持续性的胸部压迫性钝痛或压 迫感。
由于胸壁和心腔间有液体介入，心音变遥远。
Physical Examination
Compression of the base of the left lung by , pericardial fluid produces Ewart s sign, I.e., a patch（区）of dullness（浊音）on auscultation beneath the angle of the left scapula（肩胛）.
Echocardiogram
Very small effusions are likely to be imaged only posteriorly, with separation of the pericardial and epicardial echoes only in systole. Pericardial effusions of approximately 300 ml can usually be imaged both anteriorly and posteriorly
大量心包积液则可因邻近组织机械性受压而产生症状。 包括食管受压引起吞咽困难，气管、支气管受压引起 咳嗽，
History
dyspnea from lung compression with subsequent atelectasis （ 肺 不 张 ） ,hiccups （ 呃 逆 ） due to phrenic nerve compression, or hoarseness（声嘶） due to recurrent laryngeal never compression.
通常只有在积液量大于250ml时才可能出现心影增大。
Chest Roentgenogram
In some cases the heart may assume a globular or water bottle shape,blurring( 模 糊)the contours along the left cardiac border and obscuring( 遮 掩 ) the hilar( 肺 门 ) vessels.Loculated(包裹性) effusions may have a cyst-like appearance.
出现电交替提示有大量心包积液和心脏压塞。
Echocardiogram
This is the most accurate,rapid,and widely used technique for evaluating pericardial effusiong.
这是最精确，快速和广泛用来心包积液的技术。
Pericardial Effusion
The development of increased intrapericardial pressure secondary to pericardial effusion depends on several factors: ①The absolute volume of the effusion, ②The rate of fluid accumulation, and The ③The physical characteristics of the pericardium itself.
如液体迅速增加超过150-200ml，则心包腔内压会显著 上升。
Pericardial Effusion Without Cardiac Compression(不伴心脏压塞的心包积液 不伴心脏压塞的心包积液) 不伴心脏压塞的心包积液
History(病史 . 病史) 病史 Patients who develop pericardial effusion without elevation of intrapericardial pressure may have no symptoms whatsoever.
肺受压及随后出现的肺不张导致呼吸困难，膈神经受 压导致呃逆，或喉返神经受压致声嘶，邻近的腹腔脏 器受压可以产生恶心和腹胀感。
History
Nausea and a sense of abdominal fullness may be present from pressure on adjacent abdominal viscera.
二维超声心动图是目前区别全心包积液和包裹性心包 积液的金标准。
Management
The clinical significance of any pericardial effusion depends on (1) the presence or absence of hemodynamic embarrassment due to increased intrapericardial pressure and (2) the presence and nature of the und-erlying systemic disease.
Chest Roentgenogram( X线胸片) 线胸片)
Enlargement of the cardiac silhouette usually does not occur until at least 250 ml of fluid have accumulated in the pericardial space.
心包积液可出现于所有急性心包炎中，为壁层心包受 损的反应。
Pericardial Effusion
It may be clinically silent, but if the accumulation of fluid causes intrapericardial pressure to increase,resulting in cardiac compression,the symptoms of cardiac tamponade develop.
不伴心包腔内压升高的小量心包积液不产生特殊的体 征，而大量积液可产生一些特征性的体征。
Physical Examination
The heard sounds may be muffled owing to the interposition of fluid between the chest wall and the cardiac chambers.
心包腔内液体积聚时，心电图表现为非特异性的QRS 电压降低和T波低平，
Electrocardiogram
Electrical alternans suggests the presence of massive pericardial effusion and cardiac tampotion
A small pericardial effusion in the absence of an increase in intrapericardial pressure may result in no specific physical findings, whereas a large effusion may produce several characteristic physical findings.
中等到大量积液时可出现明显的心脏摆动呈假性二尖 瓣脱垂和室间隔前向运动。
Echocardiogram
Two-dimensional echocardiography is now the gold standard for identifying circumferential pericardial effusions and in identifying a loculated pericardial effusion.
History
Large pericardial effusions may cause symptoms by mechanical compression of adjacent structures, including dysphagia from esophageal compression, cough due to bronchial/tracheal compression,
很少量心包积液只有在收缩期后心包处见到心包与心 外膜间的回声分开。
Echocardiogram
Moderate to large effusions may be associated with excessive swinging motion of the heart and the false-positive appearance of mitral valve prolapse and anterior septal motion.
心包积液压迫左肺底产生Ewart征，即左肩胛角下的一 片听诊浊音区。由于肺实质受压在肺野内可闻及罗音。
Physical Examination
Rales may be heard over the lung fields secondary to compression of lung parenchyma.
PERICARDIAL EFFUSION
(心包积液)
Pericardial Effusion
Pericardial effusion may develop as a response to injury of the parietal( 壁 层 的 ) pericardium with all cases of acute pericarditis.
正常人心包腔容纳15-50ml液体，如液体积聚缓慢， 心包伸展，心包腔内可适应多达2升液体而不出现心 包腔内压升高。
Pericardial Effusion
If additional fluid is rapidly added to a volume exceeding about 150 to 200 ml, a marked rise of intrapericardial pressure occurs.
继发于心包积液的心包腔内压升高与以下几个因素 有关：①绝对的积液量；②积液产生的速度；③心 包本身的特性。
Pericardial Effusion
The pericardical space in humans normally contains between 15 and 50 ml of fluid.If additional fluid accumulates slowly, the pericardium stretches; the pericardial sac can accommodate up to 2 liters without elevation of intrapericardial pressure.
一些病例中心脏可类似球形或烧瓶性，左心缘模糊且 将肺门血管影遮掩。包裹性积液可呈现囊状表现。
Electrocardiogram
The electrocardiogram may reveal the nonspecific findings of a reduction in QRS voltage and flattening of the T waves as a fluid accumulates within the pericardial space.
有心包积液但没有心包腔内压升高的患者可以没有任 何症状。
History
Occasionally these patients complain of a constant oppressive dull ache or pressure in the chest.
偶尔这些病人会主诉有持续性的胸部压迫性钝痛或压 迫感。
由于胸壁和心腔间有液体介入，心音变遥远。
Physical Examination
Compression of the base of the left lung by , pericardial fluid produces Ewart s sign, I.e., a patch（区）of dullness（浊音）on auscultation beneath the angle of the left scapula（肩胛）.
Echocardiogram
Very small effusions are likely to be imaged only posteriorly, with separation of the pericardial and epicardial echoes only in systole. Pericardial effusions of approximately 300 ml can usually be imaged both anteriorly and posteriorly
大量心包积液则可因邻近组织机械性受压而产生症状。 包括食管受压引起吞咽困难，气管、支气管受压引起 咳嗽，
History
dyspnea from lung compression with subsequent atelectasis （ 肺 不 张 ） ,hiccups （ 呃 逆 ） due to phrenic nerve compression, or hoarseness（声嘶） due to recurrent laryngeal never compression.
通常只有在积液量大于250ml时才可能出现心影增大。
Chest Roentgenogram
In some cases the heart may assume a globular or water bottle shape,blurring( 模 糊)the contours along the left cardiac border and obscuring( 遮 掩 ) the hilar( 肺 门 ) vessels.Loculated(包裹性) effusions may have a cyst-like appearance.
出现电交替提示有大量心包积液和心脏压塞。
Echocardiogram
This is the most accurate,rapid,and widely used technique for evaluating pericardial effusiong.
这是最精确，快速和广泛用来心包积液的技术。