Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA.
AJR Am J Roentgenol. 2011 Jul;197(1):W164-8. doi: 10.2214/AJR.10.5589.
The objective of our study was to identify differences in hemorrhagic complications after ultrasound-guided thoracentesis on the basis of patient coagulation parameters.
The records of consecutive patients who underwent ultrasound-guided thoracentesis between January 1, 2008 and April 30, 2010 were reviewed to document the international normalized ratio (INR) and platelet count obtained within 72 hours before thoracentesis and to identify bleeding complications that occurred after the procedure. The observed complication rates and 95% CIs for differences in complication rates were calculated.
There were 1076 procedures performed during the study period with no hemorrhagic complications identified (0% complication rate; 95% CI, 0.00-0.34%). INR values before thoracentesis were available for 822 procedures: INR exceeded 2.0 in 139 cases (17%), 2.5 in 59 cases (7%), and 3.0 in 32 cases (4%). The 95% CI for the 0% difference in complications observed between two groups of patients determined by specific INR values was -0.008 to 0.014 (INR, 1.5), -0.007 to 0.026 (INR, 2.0), -0.007 to 0.061 (INR, 2.5), and -0.009 to 0.11 (INR, 3.0). Platelet values before thoracentesis were available for 953 procedures; the platelet count was less than 100,000/μL for 148 procedures (16%), less than 50,000/μL for 58 procedures (6%), and less than 25,000/μL for 12 procedures (1%). The 95% CI for the 0% difference in complications between two groups of patients determined by a platelet count threshold of 50,000/μL was -0.007 to 0.062.
The risk of bleeding after ultrasound-guided thoracentesis performed by radiologists is low even if the preprocedural INR and platelet count are abnormal. An approach in which no coagulation testing or correction is performed before thoracentesis may be justified.
我们的研究目的是根据患者的凝血参数，确定超声引导下胸腔穿刺后出血并发症的差异。
回顾了 2008 年 1 月 1 日至 2010 年 4 月 30 日期间连续进行超声引导下胸腔穿刺的患者的记录，记录了胸腔穿刺前 72 小时内获得的国际标准化比值（INR）和血小板计数，并确定了该操作后发生的出血并发症。计算了观察到的并发症发生率和并发症发生率差异的 95%置信区间（CI）。
研究期间共进行了 1076 例操作，未发现出血并发症（0%并发症发生率；95%CI，0.00-0.34%）。822 例胸腔穿刺前有 INR 值：INR 超过 2.0 的有 139 例（17%），2.5 的有 59 例（7%），3.0 的有 32 例（4%）。通过特定 INR 值确定的两组患者之间 0%差异的并发症观察到的 95%CI 为-0.008 至 0.014（INR，1.5），-0.007 至 0.026（INR，2.0），-0.007 至 0.061（INR，2.5），-0.009 至 0.11（INR，3.0）。953 例胸腔穿刺前有血小板值，血小板计数<100000/μL 的有 148 例（16%），血小板计数<50000/μL 的有 58 例（6%），血小板计数<25000/μL 的有 12 例（1%）。通过血小板计数阈值为 50000/μL 确定的两组患者之间 0%差异的并发症的 95%CI 为-0.007 至 0.062。
即使在操作前 INR 和血小板计数异常的情况下，放射科医生进行超声引导下胸腔穿刺后的出血风险也较低。在这种情况下，在胸腔穿刺前不进行凝血检测或纠正可能是合理的。
