关节腔积液穿刺检查

关节腔积液穿刺检查 关节腔积液穿刺检查: 一般性状检查 1(量正常关节腔内存在0.1-2ml滑膜液很难抽出。静置后不会凝固。轻度炎症时色泽变黄，因漏出的红细胞崩解，血红蛋白游离出来所致。穿刺损伤的出血，可从注射器内液体分段不均一性得到证实，职离心后上清液为深黄色是关节陈旧性出血。在严重细菌感染时，肉眼可见脓样液体，但在感染的早期滑膜液外观可以正常。乳糜样滑膜液可见于结核性关节炎、慢性类风湿关节为、急性痛风性关节炎等。 3(透明度正常滑膜液为透明清亮。混浊者可能与白细胞增加有关。还可能是大量结晶、脂肪小滴、纤维蛋白或块状的退化滑膜细胞形成的悬浮组织，可用清、微浑、浑浊等。 4(粘稠度正常滑膜液的粘稠度高。关节炎症时，由于滑膜液中透明擀酸聚合物被游离的溶解酶分解，又因炎症滑膜液增多，致使透明质酸聚合物浓度被稀释，所以滑膜液粘稠性有不同程度降低，一般用拉丝试验检查其粘稠度，此法简便。患化脓性关节炎时，则滑膜液拉不出丝来。 5(凝块形成正常滑膜液不含纤维蛋白原和其它凝血因子因此不会凝固。当炎症时，血浆中凝血因子渗出可形成凝块，凝块大小一般与炎症程度成正比。 [返回]化学检查 滑膜液的化学检查除粘蛋白凝块形成试验外，常因粘稠度高而取样困难，必要时可用透明质酸酶降低其粘度后，再测定化学成分。 1(粘蛋白凝块形成试验:正常滑膜液的粘蛋白凝块形成良好。如果凝块形成一般或差。说明透明质酸聚合物已有解聚或被稀释，可以生各种病因引起的炎症，但无鉴别诊断的价值。 2(蛋白质定量:正常滑膜液中总蛋白质为10-30g/L，其中白蛋白与球蛋白之比约为4:1，无纤维蛋白原。炎症时由于滑膜渗出增加，总蛋白、白蛋白、球蛋白和纤维蛋白原等均增加。滑膜液中蛋白质增加量可反映炎症的程度，通常SF蛋白质含量由低到高依次为:健康人、外伤性、类风湿性、感染性关节炎。 3(葡萄糖定量:测定滑膜液葡萄糖时，应同时测定患者的空腹血糖，正常滑膜液中葡萄糖比血糖稍低，其差值在0.5mmol/L以内，差值如在2.2mmol/L以上时，应考虑为化脓性关节炎。主要是由细菌对葡萄糖消耗所致的。 4(尿酸:滑膜液显微镜检查发现疑似尿酸盐结晶时，可用生化定量方法测定尿酸含量加经鉴别，这对尿酸盐育风的诊断是有价值的。 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 5(乳酸:在化脓性关节炎的滑膜液中乳酸含量明显升高，但洒病奈瑟SF的乳酸通常是正常的。类风湿性关节炎时SF乳酸可见轻度增加。至今滑膜液中乳酸含量的参考值尚无公认，因此各实验室应自行检查确定。 6(其它有报道正常滑膜液中尿素为7-12.5mmol/L，白蛋白定时为5.5-55g/L透明质酸聚合物3-4g/L，一些炎症时SF中LD活性可增加。 [返回]显微镜检查 滑膜液采集后，应立即进行检查 1(细胞计数:细胞少时应用FuchsRosenthal计数板进行计数，如用改良自动控制牛鲍计数板应增加计数面积。当细胞多时可用生理盐水稀释后计数，若粘稠度高时，计数前可用透明质酸酶处理降低粘稠度后再取标本。如契约大量红细胞而干扰折细胞计数时，应用0.1mol/L盐酸液或含10g/L白皂素的氯化钠液稀释以便函契坏红细胞。 6正常滑3膜液应无红细胞，白细胞参考范围为(200-700)×10/L。关节炎症时，白细 6胞数增加。化脓必还将有节炎时细胞数往往超过50000×10/L。在急性尿酸盐痛风、类风湿 6性关节炎进细胞数可高于20000×10/L，但淋病奈瑟菌感染的早期，滑膜液细胞通常不高。 2(细胞分类:最好采用微量细胞玻片离心沉淀收集细胞，以保存细胞的原来形态。对粘稠度高的标本可用透明质酸酶处理后再没淀，正常滑膜液中含有65%左右的单核-巨噬细胞，大约10%淋巴细胞和约20%的中性粒细胞。偶见软骨细胞、组织细胞。 炎症活动期中性粒细胞可超过75%，在化脓性关节炎时中性粒细胞可高达95%。病毒感染，结核杆菌感染时，淋巴细胞和单核细胞增加，并有可出现异型淋巴细胞。在类风湿性关节炎、痛风等病的滑膜液中可见到中性粒细胞内有大量免疫复合物形成的包涵体，呈灰色，大小约0.52μm。这种细胞称为类风湿细胞(又称“RA”细胞)。 3(结晶:滑膜液检查中很重要的内容为结晶检查，除一般生物光学显微镜检查外，最好用偏振光显微镜作鉴定。临床滑膜液常见的结晶有尿酸盐、焦磷酸钙、磷灰石、脂类和草酸钙结晶，分别存在各种痛风湿患者中，外源性结晶可见于关节手术套上的滑石粉结晶以及治疗注射后的皮质类固醇结晶。 结晶检查进用的玻片和盖玻片应该应用乙醇处理并清洁后再用试镜纸仔细擦干，以消除外来的颗粒，另一面新标本用盖玻片盖上后，其边缘最好干净的指;甲油封固，以阻止其蒸发，指甲油与滑膜液的变界处形成的结晶应忽略不计。 (1)尿酸盐结晶:在偏振光显微镜下呈双折射的针状或杆状，长度约5-20μm。注意细胞内有无此类结晶存在。若细胞内尿酸盐结晶是急性尿酸盐痛风的特征，95%急性尿酸盐痛风湿患者的SF中可找到此结晶。有尿酸盐结晶时，不能排除同时有细菌存在。 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities (2)焦磷酸钙结晶:呈比折射的捧状，长方形或菱形，长度为1-20μm。宽度约为4μm，可峥于假风湿甲状腺功能低下或甲状膀腺功能亢进的SF中。 (3)磷灰石结晶:由于它是非双折射性的，而且大小，仅1μm左右不易在光镜下认出，有时这些结晶重叠成球状时较易发现。这种结晶可被细胞吞噬后成为胞质内的包涵体。偶见于关节钙化的SF中。 (4)脂类结晶:以胆固醇结晶较为常见，除平板缺口形外，在慢性渗出液时也可呈双折射针形或菱形，见于类风湿性关节炎、结核性关节炎的SF中。 (5)草酸钙结晶:形态与尿液中草酸钙结晶相似，除游离于细胞外，有时吞噬细胞内也可出现草酸钙结晶，可见于慢性肾衰、先天性草酸盐代谢障碍引起的急、慢性关节炎的SF中。 (6)滑石粉结晶:呈十字架形，大小约为5-10μm。见于手术后残留滑石粉引起的慢性关节炎。 (7)皮质类固醇结晶:可呈针状、菱形，有时经短棒状、盘状、碎片状或重叠成大块状。这种结晶可见于注射过该药的庆节腔内，并持续数月之久。 有人发现不同的结晶可在同一标本中出现，例如尿酸盐和焦头烂额磷酸盐，尿酸盐和磷灰石结晶同时存在等。 4(其它:在系统性红斑狼疮患者的滑膜液中可找到LE细胞，但并非特异在类风湿性关节炎患者的滑膜液中有时也可能有LE细胞出现。 [返回]免疫学检查 1(类风湿因子(RF)约60%类风湿性关节炎血清的类风湿因子呈阳性，滑膜液中RF阳性率较血清高，而且早于血清中出现，胆也并非特异如结核性亲节炎时SF中也可出现RF阳性。 2(抗核抗体:已证实有70%系统性红斑狼疮和约20%的类风湿性关节炎的滑膜液中可检出抗核抗体，因此在系统性红斑狼疮如有关节炎症时，可抽取滑膜液作抗核抗体检查。 [返回]微生物学检查 微生物学检查应列入常规检查项目之一。首先应作涂片革兰氏染色，大约75%链球感染、50%革兰氏阴性杆菌感染以及25%左右的淋病奈瑟菌感染的滑膜液中可能找到细菌，如果怀疑结核性时可用ZiehlNeelson染色后寻找抗酸性杆菌，但其阳性率仅20%左右，应rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 考虑作结核性杆菌培养或PCR检查，以提高其阳性率。约30%细菌性关节炎检查不出病原菌，因此需要氧培养阴性时请勿轻易排除细菌性感染，还应想到做厌氧菌和真菌培养。 [返回]几种常见关节滑膜液的特征 常见关节炎可分成三类:非炎症性、非化脓性和化脓性。其各自滑膜液的特征见下表16-4。 表16-4 正常关节和几种常见关节炎时滑膜液的特征 细 粘胞 颜色粘蛋涂结透明稠白细胞计数及分类 蛋白质 糖 片 晶 度 度 凝或 块 培 养 与 血正淡黄糖常良200-700 ，中性粒色，清高 相无 无 10-30g/L 关好 细胞占 20% 亮 差节 不 大 损 伤 性 黄至关2000 左右， RBC 血色，良同节非多中性粒细胞占 常混高 好 上 无 无 ? 炎 炎30% 浊 症高 良同无 无 ? 1000左右中性粒退性 黄色，好 上 细胞占 15-25% 行清 性 关 节 炎 低 无 ? 非类黄至一15000-40000 中同偶化风浅绿低 般性粒细胞占 上 见无 ? rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 脓湿色混低 或胆无 60-90% ? 同性 性浊 差 固10000-12000中上 关醇黄色良性粒细胞占 50%同节结稍混好左右 上 炎 晶 浊 或1000-2000中性粒 风一无 黄色细胞占 60-70% 湿般 至乳尿 热 白色一酸 痛混浊般盐 风 低 或结 差 晶 结 核与性黄色血关混浊 25000 左右早期糖节阳中性粒细胞占 ，以相化浅灰炎 低 差 无 性 后淋巴细胞占多数 差脓或白? 化低 差 无 阳较性 色混75000左右中性粒脓性 大 浊至细胞占 75-90% 性脓样 同关上 节 炎 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities