Chen Chia-Hung, Chen Wei, Chen Hung-Jen, Yu Yang-Ho, Lin Yu-Chao, Tu Chih-Yen, Hsu Wu-Huei
Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
Ultrasound Med Biol. 2009 Sep;35(9):1468-74. doi: 10.1016/j.ultrasmedbio.2009.04.021. Epub 2009 Jul 17.
Thoracic sonography has been advocated as being complementary to small-bore catheter drainage in pleural effusions. However, it is not known whether the initial sonographic appearances of empyemas or complicated parapneumonic effusions (CPPEs) can predict the outcomes of small-bore catheter drainage for these pleural insults. This retrospective study investigated the outcomes of patients who had been diagnosed with empyema and CPPE and had received ultrasound-guided small-bore catheter (size from 12F to 16F) drainage in a tertiary university hospital from September 2005 to August 2007. Patients were excluded when empyemas or CPPEs were traumatic, they were less than 18 years old or their charts were incomplete. We evaluated 141 small-bore catheters in 70 patients with empyemas and 71 patients with CPPEs over a two-year period. The mean age was 58+/-15 y and the male gender was more frequent (112 men, 79%). The overall successful rate of small-bore catheter drainage in empyemas or CPPEs was 63% (89/141). The sonographic appearances of these empyemas or CPPEs exhibited a complex septated pattern in 57% (81/141) of patients and a complex nonseptated pattern in 43% (60/141) of patients. The success rate in a complex nonseptated sonographic pattern was significantly higher than in a complex septated sonographic pattern (48/60, 80% vs. 41/81, 51%, respectively; p=0.001). Moreover, patients with complex septated sonographic patterns also had higher intensive care unit admission rates compared with nonseptated sonographic patterns (22/81, 27%, vs. 8/60, 13%, respectively; p=0.0047), as well as infection-related mortality rates (17/81, 21% vs. 4/60, 7%, respectively; p=0.018). The appearance of sonographic septation is a useful sign to help predict the outcome of small-bore catheter drainage in cases of empyemas or CPPEs. Patients with a complex septated sonographic pattern have a poorer prognosis for a successful outcome, higher ICU admission rate and a higher mortality rate.
胸腔超声检查被认为是对胸腔积液小口径导管引流的一种补充。然而，目前尚不清楚脓胸或复杂性肺炎旁胸腔积液（CPPE）的初始超声表现是否能够预测这些胸腔病变进行小口径导管引流的效果。这项回顾性研究调查了2005年9月至2007年8月期间在一所三级大学医院被诊断为脓胸和CPPE并接受超声引导下小口径导管（尺寸为12F至16F）引流的患者的治疗效果。当脓胸或CPPE为创伤性、患者年龄小于18岁或病历不完整时，将患者排除。在两年期间，我们评估了70例脓胸患者和71例CPPE患者的141根小口径导管。平均年龄为58±15岁，男性更为常见（112例男性，占79%）。脓胸或CPPE患者小口径导管引流的总体成功率为63%（89/141）。这些脓胸或CPPE的超声表现中，57%（81/141）的患者呈现复杂分隔模式，43%（60/141）的患者呈现复杂非分隔模式。复杂非分隔超声模式的成功率显著高于复杂分隔超声模式（分别为48/60，80%和41/81，51%；p=0.001）。此外，与非分隔超声模式相比，具有复杂分隔超声模式的患者重症监护病房入住率也更高（分别为22/81，27%和8/60，13%；p=0.0047），以及感染相关死亡率也更高（分别为17/81，21%和4/60，7%；p=0.018）。超声分隔的表现是帮助预测脓胸或CPPE病例中小口径导管引流效果的一个有用征象。具有复杂分隔超声模式的患者成功治疗的预后较差、重症监护病房入住率较高且死亡率较高。
