Özturan İbrahim Ulaş, Doğan Nurettin Özgür, Alyeşil Cansu, Pekdemir Murat, Yılmaz Serkan, Sezer Hüseyin Fatih
Kocaeli University, Faculty of Medicine, Department of Emergency Medicine, Kocaeli, Turkey.
Kocaeli University, Faculty of Medicine, Department of Thoracic Surgery, Kocaeli, Turkey.
Turk J Emerg Med. 2018 May 24;18(3):105-110. doi: 10.1016/j.tjem.2018.05.002. eCollection 2018 Sep.
Traumatic iatrogenic pneumothorax occurs most often after a transthoracic needle biopsy. Since this procedure has become a common outpatient intervention, emergency department admissions of post-biopsy pneumothorax patients have increased. The aim of this study was to determine the factors that predict the need for tube thoracostomy in patients with post-biopsy pneumothorax in the emergency department.
A retrospective cross-sectional study was conducted on 191 patients with post-biopsy pneumothorax who were admitted to the emergency department between 2010 and 2017. Patient characteristics, clinical findings at the emergency department presentation, and procedural and radiological features were reviewed. A multivariate logistic regression model was constructed using the variables from univariate comparisons to determine the need for tube thoracostomy in patients with iatrogenic pneumothorax, and the effect sizes were demonstrated with odds ratios.
Tube thoracostomies were performed on 69 out of 191 patients (36.1%). A total of 122 patients (63.9%) were treated with supplemental oxygen therapy without any other intervention, and 126 patients (66.0%) were hospitalized. In the multivariate model, the variables predicting the need for a tube thoracostomy were decreased breath sounds, dyspnea, decreased systolic blood pressure, decreased oxygen saturation and increased pleura-lesion distance. A distance of 19.7 mm predicted the need with a sensitivity of 69.6% and a specificity of 62.3%.
Decreased breath sounds, dyspnea, decreased systolic blood pressure, decreased oxygen saturation, and increased pleura-lesion distance may predict the need for a tube thoracostomy in patients with post-biopsy pneumothorax.
创伤性医源性气胸最常发生于经胸壁针吸活检术后。由于该操作已成为常见的门诊干预手段，活检后气胸患者的急诊科收治人数有所增加。本研究的目的是确定预测急诊科活检后气胸患者需要进行胸腔闭式引流的因素。
对2010年至2017年间收治于急诊科的191例活检后气胸患者进行回顾性横断面研究。回顾患者特征、急诊科就诊时的临床表现以及操作和影像学特征。使用单因素比较中的变量构建多因素逻辑回归模型，以确定医源性气胸患者是否需要进行胸腔闭式引流，并以比值比展示效应大小。
191例患者中有69例（36.1%）进行了胸腔闭式引流。共有122例患者（63.9%）接受了补充氧气治疗，未进行任何其他干预，126例患者（66.0%）住院治疗。在多因素模型中，预测需要进行胸腔闭式引流的变量包括呼吸音减弱、呼吸困难、收缩压降低、血氧饱和度降低以及胸膜病变距离增加。19.7毫米的距离预测需要进行胸腔闭式引流的敏感性为69.6%，特异性为62.3%。
呼吸音减弱、呼吸困难、收缩压降低、血氧饱和度降低以及胸膜病变距离增加可能预测活检后气胸患者需要进行胸腔闭式引流。
