Feller-Kopman David, Walkey Allan, Berkowitz David, Ernst Armin
Interventional Pulmonology, Beth Israel Deaconess Medical Center, Deaconess 201, One Brookline Ave, Boston, MA 02215, USA.
Chest. 2006 Jun;129(6):1556-60. doi: 10.1378/chest.129.6.1556.
To describe the relationship of patients' symptoms during therapeutic thoracentesis to pleural pressure (Ppl).
Review of prospectively collected data during 169 therapeutic thoracentesis procedures.
University Hospital in Boston, MA.
One hundred sixty-nine patients who had Ppl measured during therapeutic thoracentesis were included in this study. End-expiratory pressures were measured after the withdrawal of 5 mL of fluid and every 240 mL thereafter until the pressure was lower than -20 cm H(2)O, chest discomfort developed in the patient, or no more fluid could be removed. Patients' symptoms, including chest pain, chest discomfort, and cough were recorded simultaneously.
There was no correlation between the amount of pleural fluid removed and the development of symptoms. The closing pressures and the total change in Ppl (see the "Materials and Methods" section for definitions), however, were significantly lower in the group of patients who experienced chest discomfort compared to patients who developed cough or were asymptomatic. There was also a trend toward a significantly lower pleural elastance in patients who developed cough compared to that in the other two groups. Additionally, only 22% of patients in whom chest discomfort developed, and 8.6% of patients in whom symptoms did not develop, had potentially dangerous Ppl values (ie, lower than -20 cm H(2)O).
The development of chest discomfort is associated with a potentially unsafe drop in Ppl values and should be a sign to terminate thoracentesis. It is not necessary to terminate thoracentesis solely because of the development of cough. Without attention to pleural manometry, a significant percentage of patients may develop potentially dangerous Ppl. Although we recommend pleural manometry with all thoracenteses, when it is not used attention to symptoms remains a valuable surrogate.
描述治疗性胸腔穿刺术期间患者症状与胸膜压力（Ppl）之间的关系。
回顾169例治疗性胸腔穿刺术过程中前瞻性收集的数据。
马萨诸塞州波士顿的大学医院。
本研究纳入了169例在治疗性胸腔穿刺术期间测量了Ppl的患者。在抽出5 mL液体后测量呼气末压力，此后每抽出240 mL测量一次，直至压力低于-20 cm H₂O、患者出现胸部不适或无法再抽出液体。同时记录患者的症状，包括胸痛、胸部不适和咳嗽。
抽出的胸腔积液量与症状的出现之间无相关性。然而，与出现咳嗽或无症状的患者相比，出现胸部不适的患者组的闭合压力和Ppl的总变化（定义见“材料与方法”部分）显著更低。与其他两组相比，出现咳嗽的患者的胸膜弹性也有显著降低的趋势。此外，出现胸部不适的患者中只有22%，无症状患者中只有8.6%的Ppl值存在潜在危险（即低于-20 cm H₂O）。
胸部不适的出现与Ppl值潜在不安全的下降有关，应作为终止胸腔穿刺术的指征。不必仅因咳嗽的出现而终止胸腔穿刺术。如果不关注胸膜测压，相当一部分患者可能会出现潜在危险的Ppl。虽然我们建议所有胸腔穿刺术都进行胸膜测压，但在未进行胸膜测压时，关注症状仍然是一种有价值的替代方法。
