Grogan D R, Irwin R S, Channick R, Raptopoulos V, Curley F J, Bartter T, Corwin R W
Department of Medicine, University of Massachusetts Medical School, Worcester.
Arch Intern Med. 1990 Apr;150(4):873-7. doi: 10.1001/archinte.150.4.873.
To determine what role the technique plays in complications associated with thoracentesis performed by physicians in training, we undertook a prospective study of thoracentesis in the medical service at our institution in which the sampling method was randomized among needle, needle with catheter, and needle with direct sonographic guidance. Fifty-two spontaneously breathing, cooperative patients with free-flowing effusions obliterating more than half of the hemidiaphragm on an upright, posteroanterior chest roentgenogram were randomized. When we analyzed those complications that were potentially life-threatening (eg, pneumothorax) and/or placed patients at increased risk for further morbidity (eg, pneumothorax, dry tap, inadequate tap), the sonography-guided method was associated with significantly fewer serious complications (0 of 19) than the needle-catheter (9 of 18) or needle-only methods (5 of 15). The sonography-guided method was associated with fewer pneumothoraces (0 of 19) than the needle-catheter (7 of 18) or needle-only methods (3 of 15). The difference between needle-catheter and needle-only methods was not significant. From our results, we conclude that the method by which thoracentesis was performed significantly influenced the spectrum and frequency of complications, and the sonography-guided method was the safest.
为了确定该技术在实习医生进行胸腔穿刺术相关并发症中所起的作用，我们在本机构的内科服务部门对胸腔穿刺术进行了一项前瞻性研究，其中采样方法在针吸、带导管针吸和直接超声引导针吸之间随机分配。52例在直立后前位胸部X线片上有自由流动积液且积液超过半侧膈肌的自主呼吸、配合良好的患者被随机分组。当我们分析那些可能危及生命的并发症（如气胸）和/或使患者进一步发病风险增加的并发症（如气胸、干抽、穿刺不足）时，超声引导方法的严重并发症（19例中0例）明显少于带导管针吸法（18例中9例）或单纯针吸法（15例中5例）。超声引导方法的气胸发生率（19例中0例）低于带导管针吸法（18例中7例）或单纯针吸法（15例中3例）。带导管针吸法和单纯针吸法之间的差异不显著。根据我们的结果，我们得出结论，胸腔穿刺术的实施方法显著影响并发症的范围和频率，超声引导方法是最安全的。
