Feller-Kopman David
Medical Procedure Service, Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Curr Opin Pulm Med. 2007 Jul;13(4):312-8. doi: 10.1097/MCP.0b013e3281214492.
Therapeutic thoracentesis is one of the most commonly performed medical procedures. The availability of handheld ultrasound machines has greatly enhanced the evaluation and management of patients with pleural effusions, with advantages including the absence of radiation, ease of use, portability and real-time/dynamic imaging. Pleural manometry refers to the measurement of pleural pressure during thoracentesis. Though described more than 122 years ago, most physicians do not measure pleural pressure, or even consider the role pleural pressures plays in the development of pleural effusions. This review summarizes the relevant data behind the use of ultrasound and manometry and explores their use during therapeutic thoracentesis
The use of ultrasound has been associated with a higher sensitivity for identifying pleural effusions, avoiding 'near misses' and a lower pneumothorax rate for thoracentesis. Pleural manometry can be used to distinguish patients with lung entrapment from those with trapped lung. Manometry is also able to predict the ability to pleurodesis patients with malignant effusions, and possibly minimize the risk of reexpansion pulmonary edema when large volumes of pleural fluid are removed.
The use of ultrasound and pleural manometry enhances the understanding of pleural disease and is associated with clinical benefit that will lead to improved patient care.
治疗性胸腔穿刺术是最常用的医疗操作之一。手持式超声仪的出现极大地改善了胸腔积液患者的评估与管理，其优点包括无辐射、使用便捷、便于携带以及实时/动态成像。胸膜测压是指在胸腔穿刺术期间测量胸膜压力。尽管早在122多年前就有相关描述，但大多数医生并不测量胸膜压力，甚至不考虑胸膜压力在胸腔积液形成过程中所起的作用。本综述总结了超声和测压使用背后的相关数据，并探讨了它们在治疗性胸腔穿刺术中的应用。
超声的使用与更高的胸腔积液识别灵敏度、避免“险些失误”以及更低的胸腔穿刺气胸发生率相关。胸膜测压可用于区分肺陷闭患者和肺被包裹患者。测压还能够预测恶性胸腔积液患者胸膜固定术的可行性，并有可能在大量胸腔积液被抽出时将复张性肺水肿的风险降至最低。
超声和胸膜测压的使用增进了对胸膜疾病的理解，并具有临床益处，将改善患者护理。
