文献詳細
特集 術後呼吸器合併症―予防と対策の最新知識
文献概要
要旨:健常人において,胸膜腔にはごく少量の胸水が貯留しているが,外科手術後には手術侵襲に伴う体液の移動や代謝異化に伴う血漿膠質浸透圧の低下などによって高率にその増加がみられる.術後胸水は,そのほとんどが無症候性であり格別治療を要するものではないが,ときに治療を要する症例にも遭遇する.胸水貯留の病態は複雑であり,かつそれぞれの症例で多様であるため,手術後に胸水の貯留がみられた場合には,臨床症状や身体所見および画像所見などによってその量や性状を確認し,必要により胸腔穿刺を行ったうえで各症例における病態を把握して,それに沿った治療方針を立てることが肝要である.
参考文献
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