《脑脊液检查》PPT课件.ppt
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1、1,脑脊液检查,2,choroid plexus(脉络丛) lateral ventricles(侧脑室) the line of the fornix(穹隆) the third ventricle(第三脑室) cerebral aqueduct (导水管) the fourth ventricle(第四脑室) lateral and median apertures(侧、中央孔) arachnoid granulations(蛛网膜) Venous system(静脉系统),How the CSF is produced and circulated,3,脑脊液生成图,choroid pl
2、exus(脉络丛) lateral ventricles(侧脑室) the line of the fornix (穹隆) the third ventricle (第三脑室) cerebral aqueduct (导水管) the fourth ventricle (第四脑室) lateral and median apertures (侧、中央孔) arachnoid granulations (蛛网膜) Venous system(静脉系统),4,How the CSF looks like?,circulates in the space surrounding the spinal
3、cord and brain CSF is a clear fluid occupies the subarachnoid space in the brain,5,CSF,70% 侧脑室脉络丛通过主动分泌和超滤生成 30% 大脑和脊髓的细胞间隙形成间质液,6,Function of CSF(脑脊液的功能),protection 保护作用 a buffer for the cortex(大脑皮层),protecting the brain and spine from injury matter exchange 物质交换中介 distribution of neuroendocrine fa
4、ctors,such as ACTH,TSH,et al. exchange matters, transport nutrition into brain and export rubbish from brain acid-alkali regulating 酸碱调节作用 regulating the acid-alkali balance,7,BBB(blood-brain barrier),脉络丛 (BBB 的形成依赖于脉络丛的内皮细胞对不同物质的通透性),小分子物质,中分子物质,大分子物质,8,diseases is occurred in brain BBB will be dis
5、rupted penetration will be increased components in CSF is changed (large molecule substance will go into the CSF),9,脑脊液采集的适应证,脑膜刺激症状 疑有颅内出血时,不能作CT检查 剧烈头痛、昏迷、抽搐或瘫痪等症状体征而原因不明 脑膜白血病患者 中枢神经系统疾病进行椎管内给药治疗、手术、前腰麻、造影等,10,脑脊液采集的禁忌症,凡疑有颅内压升高者必须做眼底检查,如有明显视乳头水肿或有脑疝先兆者,禁忌穿刺。 凡病人处于休克、衰竭或濒危状态以及局部皮肤有炎症、 颅后窝有占位性病变或伴
6、有脑干症状者均禁忌穿刺。 开放性颅脑损伤或有脑脊液漏者。,11,Sample collecting(标本采集),腰椎穿刺 (lumbar puncture) 先作压力测定 再收集到三支试管内 样本需要立即送检,link,link,link,12,lumbar puncture,L3-L4 vertebral level,back,13,压力测定,参考值: 0.78-1.76kpa (80-180mmH2O) 任何病变使脑组织体积或脑脊液量增加时,脑脊液压力均可升高 。,14,由于颅骨空间很固定,因此,脑内任何组分体积的增加都会导致压力增加 (such as blood, CSF, or bra
7、in tissue) 增加:充血性心衰、脑膜炎、脑水肿等 减低:脱水 、脑脊液漏等,back,临床意义,15,样本的采集,1-2ml/each tube microbial analysis(细菌培养) (第一管) biochemical and immunological analysis (化学分析和免疫学检查 ) (第二管) Macroscopic and microscopic analysis(一般性状及显微镜检查) (第三管),back,16,contents,外观检查(Macroscopic examination) 化学检查(Chemical examination) 显微镜检
8、查(Microscopic analysis) 免疫学检查(Immunological analysis) 微生物学检查(Microbe analysis),17,颜色 Color 透明度 Diaphaneity 薄膜或凝块 pellicle formation and clot,Macroscopic examination,18,colors,正常: 无色 有颜色说明脑脊液异常 红色 red 黄色 xanthochromia 白色或灰色white or grey 绿色green 黑色或褐色black or brown,19,red,Can be caused by operating da
9、mnification or brain hemorrhage. caused by operating: bleeding will stopped because of the coagulating cascade. Caused by brain hemorrhage: RBC will be destroyed because of the different osmotic pressure from CSF to plasma.,20,tests used to identification three tubes test 三管试验 centrifugal test 离心试验
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