Potechin Rajini, Amjadi Kayvan, Srour Nadim
Ther Adv Respir Dis. 2015 Feb;9(1):22-7. doi: 10.1177/1753465814565353.
Pleural effusions are a common complication of end-stage renal disease.These effusions are occasionally refractory to medical management, but few options are then available. Indwelling pleural catheter insertion (IPC) has been well described for the management of malignant pleural effusions and, more recently, of nonmalignant effusions of other origin. We aimed to analyze our experience and to evaluate the safety and feasibility of using IPCs for pleural effusion associated with end-stage renal disease.
We constructed a cohort of patients who underwent IPC insertion for pleural effusions associated with end-stage renal disease. The IPCs were inserted as a palliative measure in patients who had thoracentesis twice within the preceding 2 weeks, no evidence of infection and either failure to respond, complications or intolerance to maximal medical therapy, or if IPC insertion would enable discharge when the patient was hospitalized mainly for dyspnea due to pleural effusion.
There were nine IPCs inserted in eight patients. Patients had significant dyspnea at baseline with a median baseline dyspnea index of 1.5 [interquartile range (IQR) 0–3]. Dyspnea improved significantly 2 weeks after catheter insertion with a median transitional dyspnea index of 6 (IQR 4.5–7.0). There was no occurrence of empyema or other major complications.Serum albumin did not decrease after catheter insertion. IPCs were removed in four patients(50%) and successful spontaneous pleurodesis occurred in three patients (37.5%) after a median of 77 days (IQR 9–208).
IPC insertion for pleural effusions associated with end-stage renal disease appears safe and effective. Larger studies are needed, particularly regarding the impact of this intervention on quality of life.
胸腔积液是终末期肾病的常见并发症。这些积液有时对药物治疗无效，但此时可供选择的方案很少。留置胸腔导管插入术（IPC）已被广泛用于治疗恶性胸腔积液，最近也用于治疗其他原因引起的非恶性积液。我们旨在分析我们的经验，并评估使用IPC治疗终末期肾病相关胸腔积液的安全性和可行性。
我们构建了一组因终末期肾病相关胸腔积液而接受IPC插入术的患者队列。对于在过去2周内进行过两次胸腔穿刺、无感染证据且对最大药物治疗无反应、出现并发症或不耐受，或者因胸腔积液导致呼吸困难而住院且插入IPC可使其出院的患者，将IPC作为一种姑息性措施插入。
8例患者共插入9根IPC。患者基线时存在明显呼吸困难，基线呼吸困难指数中位数为1.5[四分位间距（IQR）0 - 3]。导管插入后2周呼吸困难显著改善，过渡性呼吸困难指数中位数为6（IQR 4.5 - 7.0）。未发生脓胸或其他主要并发症。导管插入后血清白蛋白未降低。中位77天（IQR 9 - 208）后，4例患者（50%）拔除了IPC，3例患者（37.5%）成功实现了自发性胸膜固定术。
插入IPC治疗终末期肾病相关胸腔积液似乎安全有效。需要进行更大规模的研究，特别是关于这种干预对生活质量的影响。
