Patel Sanjay R, Karmpaliotis Dimitri, Ayas Najib T, Mark Eugene J, Wain John, Thompson B Taylor, Malhotra Atul
Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston, MA 02115, USA.
Chest. 2004 Jan;125(1):197-202. doi: 10.1378/chest.125.1.197.
The role of open-lung biopsy in ARDS has been questioned due to potentially high morbidity and low diagnostic yield. The goals of this study were to better define the frequency of unexpected diagnoses made by open-lung biopsy, the frequency biopsy results lead to a change in clinical management, and the frequency of procedural complications.
Case series.
A large tertiary referral center.
All individuals with available records undergoing open-lung biopsy between 1989 and 2000 for evaluation of ARDS based on the American-European Consensus Conference definition.
None.
The mean age in this cohort of 57 patients was 53 years (SD, 18 years) with PaO(2)/fraction of inspired oxygen ratio of 145 mm Hg (SD, 61 mm Hg) at the time of biopsy. A pathologic diagnosis other than diffuse alveolar damage or fibroproliferation was found in 60% of patients. The most common alternative diagnoses were infection (n = 8), alveolar hemorrhage (n = 5), and bronchiolitis obliterans organizing pneumonia (n = 5). Alternative diagnoses were as frequent in immunocompetent as immunosuppressed hosts (60% vs 59%, respectively). Biopsy results led to a change in management in the majority of patients, with addition of specific therapy in 60% and withdrawal of unneeded therapy in 37%. Although the overall complication rate was 39%, major complications occurred in only 7% of cases. No deaths were attributable to the procedure.
In selected patients with clinical ARDS, open-lung biopsy can be performed safely, often reveals an unsuspected diagnosis, and frequently leads to alterations in therapy.
由于开胸肺活检可能具有较高的发病率和较低的诊断率，其在急性呼吸窘迫综合征（ARDS）中的作用受到质疑。本研究的目的是更好地确定开胸肺活检意外诊断的频率、活检结果导致临床管理改变的频率以及手术并发症的频率。
病例系列研究。
一家大型三级转诊中心。
所有在1989年至2000年间根据欧美共识会议定义接受开胸肺活检以评估ARDS且有可用记录的个体。
无。
该队列中的57例患者平均年龄为53岁（标准差18岁），活检时的氧合指数（PaO₂/吸入氧分数）为145 mmHg（标准差61 mmHg）。6０%的患者被发现有除弥漫性肺泡损伤或纤维增生以外的病理诊断。最常见的其他诊断为感染（8例）、肺泡出血（5例）和闭塞性细支气管炎伴机化性肺炎（5例）。免疫功能正常宿主和免疫抑制宿主的其他诊断频率相同（分别为60%和59%）。活检结果导致大多数患者的管理发生改变，60%的患者增加了特异性治疗，37%的患者停用了不必要的治疗。尽管总体并发症发生率为39%，但严重并发症仅发生在7%的病例中。没有死亡病例归因于该手术。
在选定的临床ARDS患者中，开胸肺活检可以安全地进行，常常能揭示意外诊断，并经常导致治疗改变。
