05 - 205anatomi Dan Fisiologi Pleura
05 - 205anatomi Dan Fisiologi Pleura
ABSTRAK
Pleura merupakan membran serosa intratoraks yang membatasi rongga pleura, secara embriogenik berasal dari jaringan selom intraembrionik;
terdiri dari pleura viseral dan pleura parietal. Pleura viseral dan parietal merupakan jaringan berbeda yang memiliki inervasi dan vaskularisasi
berbeda pula. Pleura secara mikroskopis tersusun atas selapis mesotel, lamina basalis, lapisan elastik superfisial, lapisan jaringan ikat longgar,
dan lapisan jaringan fibroelastik dalam. Tekanan pleura bersama tekanan jalan napas menimbulkan tekanan transpulmoner yang memengaruhi
pengembangan paru dalam proses respirasi. Cairan pleura dalam jumlah tertentu berfungsi untuk memungkinkan pergerakan kedua pleura
tanpa hambatan selama proses respirasi. Keseimbangan cairan pleura diatur melalui mekanisme hukum Starling dan sistem penyaliran limfatik
pleura. Rongga pleura merupakan rongga potensial yang dapat mengalami efusi akibat penyakit yang mengganggu keseimbangan cairan
pleura. Karakteristik pleura lain penting diketahui sebagai dasar pemahaman patofisiologi kelainan pleura dan gangguan proses respirasi.
Kata kunci: pleura, mesotel, respirasi, tekanan pleura, efusi pleura
ABSTRACT
Pleura is an intrathoracic serous membrane, derived from primitive intraembryonic coelom tissue; consists of visceral pleura and parietal pleura.
These pleuras enclose different intrathoracic organs and have different innervation and vascularization. Pleura microscopically consists of single
layer of mesothel, basal lamina, elastic layer, loose connective tissue layer and deeper fibro-elastic layer. Pleural pressure along with airway
pressure will produce transpulmonary pressure which will drive lung expansion, thus respiration process. Pleural fluid provides lubrication to
lessen friction between visceral pleura and parietal pleura during respiration movement, its equilibrium is governed by Starlings law and pleural
lymphatic drainage system. Pleural cavity should be considered as potential space; effusion could be caused by diseases that disrupt pleural
fluid equilibrium. Characteristics of pleura should be well acknowledged and understood as the basic for understanding the pathophysiology
of pleural abnormalities and respiratory diseases. Irandi Putra Pratomo, Faisal Yunus. Anatomy and Physiology of Pleura.
Key words: pleura, mesothel, respiration, pleural pressure, pleural effusion
PENDAHULUAN
Pleura merupakan membran serosa yang
melingkupi parenkim paru, mediastinum,
diafragma serta tulang iga; terdiri dari
pleura viseral dan pleura parietal.1,2 Rongga
pleura terisi sejumlah tertentu cairan
yang memisahkan kedua pleura tersebut
sehingga
memungkinkan
pergerakan
kedua pleura tanpa hambatan selama
proses respirasi.1,3 Cairan pleura berasal
dari pembuluh-pembuluh kapiler pleura,
ruang interstitial paru, kelenjar getah bening
intratoraks, pembuluh darah intratoraks dan
rongga peritoneum. Jumlah cairan pleura
dipengaruhi oleh perbedaan tekanan antara
pembuluh-pembuluh kapiler pleura dengan
rongga pleura sesuai hukum Starling serta
kemampuan eliminasi cairan oleh sistem
Alamat korespondensi
email: irhotep@gmail.com
407
Gambar 2 Perkembangan rongga pleura dan perikardium pada janin mamalia. (A) Tahap awal menunjukkan janin masih
memiliki tiga rongga yaitu rongga perikardium, rongga peritoneum dan sepasang kanalis perikardioperitoneum, (B) kanalis
perikardioperitoneum selanjutnya terpisah dan terbentuk rongga pleura dan rongga perikardium dibatasi membran pleuroperikardium, (C) hingga akhirnya pleura viseral berkembang meliputi paru berhadapan dengan pleura parietal10
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Peningkatan cairan interstitial paru : Gagal jantung kiri, pneumonia, emboli paru
Peningkatan tekanan intravaskular pleura : Gagal jantung kanan atau kiri, sindrom vena kava superior
Peningkatan permeabilitas kapiler pleura : Inflamasi pleura, peningkatan kadar VEGF
Peningkatan kadar protein cairan pleura
Penurunan tekanan pleura : Atelektasis, peningkatan rekoil elastik paru
Peningkatan akumulasi cairan peritoneum : Asites, dialisis peritoneum
Disrupsi duktus torasikus
Disrupsi pembuluh darah rongga dada
Gambar 4 Skema tekanan dan pergerakan cairan pada rongga pleura manusia4
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