Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, La Coruña, España.
Servicio de Análisis Clínicos, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, La Coruña, España; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, La Coruña, España.
Arch Bronconeumol. 2016 Apr;52(4):189-95. doi: 10.1016/j.arbres.2015.07.011. Epub 2015 Oct 1.
In the absence of firm recommendations, we analyzed whether unilateral thoracic puncture is sufficient for bilateral pleural effusion (PE), or if the procedure needs to be performed in both sides.
Prospective study of patients seen consecutively for bilateral PE during a period of 3 years and 9 months. All patients underwent simultaneous bilateral thoracocentesis. The standard protocol variables collected in our hospital served as study parameters. Size of PE, presence of chest pain or fever, or accompanying lung abnormalities, different attenuation values on chest computed tomography, presence of loculated pleural fluid, and radiological resolution in a single side were also evaluated.
A total of 36 patients (19 men; mean age 68.5 ± 16.5 years) were included. The etiology of the effusion was different in each side in only 2 patients (5.6%). In 6/32 cases (18.8%), the biological analysis of the pleural fluid (in terms of transudate/exudate) from both sides did not correspond with the etiological diagnosis of the effusion. Correlation between biochemical parameters analyzed in the fluid from both sides (Pearson's correlation coefficient) ranged between 0.74 (LDH) and 0.998 (NT-proBNP). As different diagnoses in each side were found in only 2 patients, the circumstances in which bilateral diagnostic thoracocentesis would be necessary could not be determined.
Simultaneous bilateral thoracocentesis does not appear to be recommendable. Larger series are needed to establish which factors might suggest the need for simultaneous puncture of both PE.
由于缺乏明确的建议，我们分析了单侧胸腔穿刺术是否足以处理双侧胸腔积液（PE），或者是否需要在两侧都进行该操作。
对 3 年零 9 个月期间连续因双侧 PE 就诊的患者进行前瞻性研究。所有患者均接受了双侧胸腔穿刺术。我们医院收集的标准方案变量作为研究参数。评估了胸腔积液的大小、胸痛或发热的存在、或伴随的肺部异常、胸部 CT 上的不同衰减值、存在分隔性胸腔积液以及单侧的影像学改善。
共纳入 36 例患者（19 例男性；平均年龄 68.5 ± 16.5 岁）。仅在 2 例患者（5.6%）中，两侧胸腔积液的病因不同。在 6/32 例（18.8%）中，两侧胸腔积液的生物分析（根据渗出液/漏出液）与胸腔积液的病因诊断不符。两侧胸腔积液生化参数分析之间的相关性（Pearson 相关系数）在 0.74（LDH）和 0.998（NT-proBNP）之间。由于仅在 2 例患者中发现两侧有不同的诊断，因此无法确定哪些情况下需要同时进行双侧诊断性胸腔穿刺。
同时进行双侧胸腔穿刺术似乎不可推荐。需要更大的系列研究来确定哪些因素可能提示需要同时穿刺双侧胸腔积液。
