Yale University, Section of Pulmonary and Critical Care Medicine, United.
Respir Med. 2013 Feb;107(2):284-91. doi: 10.1016/j.rmed.2012.10.004. Epub 2012 Dec 7.
To evaluate the safety, etiology and outcomes of patients undergoing bilateral thoracentesis.
This is a prospective cohort study of 100 consecutive patients who underwent bilateral thoracenteses in an academic medical center from July 2009 through November 2010. Pleural fluid characteristics and etiologies of the effusions were assessed. Mean differences in levels of fluid characteristics between right and left lungs were tested. Associations between fluid characteristics and occurrence of bilateral malignant effusions were evaluated. The rate of pneumothorax and other complications subsequent to bilateral thoracentesis was determined.
Exudates were more common than transudates, and most effusions had multiple etiologies, with 83% having two or more etiologies. Bilateral malignant effusions occurred in 19 patients, were the most common single etiology of exudative effusions, and were associated with higher levels of protein and LDH in the pleural fluid. Among 200 thoracenteses performed with a bilateral procedure, seven resulted in pneumothoraces, three of which required chest tube drainage and four were ex vacuo.
More often than not, there are multiple etiologies that contribute to pleural fluid formation, and of the combinations of etiologies observed congestive heart failure was the most frequent contributor. Exudative effusions are more common than transudates when bilateral effusions are present. Malignancy is a common etiology of exudative effusions. This study suggests that the overall complication rate following bilateral thoracentesis is low and the rate of pneumothorax subsequent to bilateral thoracentesis is comparable to unilateral thoracentesis.
评估行双侧胸腔穿刺术患者的安全性、病因和结局。
这是一项前瞻性队列研究，纳入了 2009 年 7 月至 2010 年 11 月在一所学术医疗中心行双侧胸腔穿刺术的 100 例连续患者。评估胸腔积液特征和积液病因。测试右肺和左肺之间液体特征水平的差异。评估液体特征与双侧恶性胸腔积液发生之间的关联。确定双侧胸腔穿刺术后气胸和其他并发症的发生率。
渗出液比漏出液更常见，大多数胸腔积液有多种病因，83%的胸腔积液有两种或两种以上病因。19 例患者出现双侧恶性胸腔积液，是渗出性胸腔积液最常见的单一病因，且胸腔积液中的蛋白和 LDH 水平较高。在 200 例双侧胸腔穿刺术中，有 7 例发生气胸，其中 3 例需要胸腔引流，4 例为真空性气胸。
常常存在多种导致胸腔积液形成的病因，在观察到的病因组合中，充血性心力衰竭是最常见的病因。当存在双侧胸腔积液时，渗出性胸腔积液比漏出液更常见。恶性肿瘤是渗出性胸腔积液的常见病因。本研究表明，双侧胸腔穿刺术后的总体并发症发生率较低，且双侧胸腔穿刺术后气胸的发生率与单侧胸腔穿刺术相当。
