Senitko Michal, Ray Amrik S, Murphy Terrence E, Araujo Katy L B, Bramley Kyle, DeBiasi Erin M, Pisani Margaret A, Cameron Kelsey, Puchalski Jonathan T
Division of Pulmonary, Critical Care and Sleep Medicine, University of Mississippi Medical Center School of Medicine, Jackson, MS.
Division of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine.
J Bronchology Interv Pulmonol. 2019 Jul;26(3):166-171. doi: 10.1097/LBR.0000000000000556.
Pleural effusions may be aspirated manually or via vacuum during thoracentesis. This study compares the safety, pain level, and time involved in these techniques.
We randomized 100 patients receiving ultrasound-guided unilateral thoracentesis in an academic medical center from December 2015 through September 2017 to either vacuum or manual drainage. Without using pleural manometry, the effusion was drained completely or until the development of refractory symptoms. Measurements included self-reported pain before and during the procedure (from 0 to 10), time for completion of drainage, and volume removed. Primary outcomes were rates of all-cause complications and of early termination of the procedure with secondary outcomes of change in pain score, drainage time, volume removed, and inverse rate of removal.
Patient characteristics in the manual (n=49) and vacuum (n=51) groups were similar. Rate of all-cause complications was higher in the vacuum group (5 vs. 0; P=0.03): pneumothorax (n=3), surgically treated hemothorax with subsequent death (n=1) and reexpansion pulmonary edema causing respiratory failure (n=1), as was rate of early termination (8 vs. 1; P=0.018). The vacuum group exhibited greater pain during drainage (P<0.05), shorter drainage time (P<0.01), no association with volume removed (P>0.05), and lower inverse rate of removal (P≤0.01).
Despite requiring less time, vacuum aspiration during thoracentesis was associated with higher rates of complication and of early termination of the procedure and greater pain. Although larger studies are needed, this pilot study suggests that manual aspiration provides greater safety and patient comfort.
胸腔穿刺术期间，胸腔积液可通过手动抽吸或负压抽吸。本研究比较了这些技术的安全性、疼痛程度和所需时间。
2015年12月至2017年9月期间，我们将在一所学术医疗中心接受超声引导下单侧胸腔穿刺术的100例患者随机分为负压抽吸组或手动引流组。在不使用胸膜测压法的情况下，将胸腔积液完全引流或直至出现难治性症状。测量指标包括患者在操作前和操作过程中的自我报告疼痛程度（0至10分）、引流完成时间和引流量。主要结局是全因并发症发生率和操作提前终止率，次要结局是疼痛评分变化、引流时间、引流量和引流速度倒数。
手动引流组（n = 49）和负压抽吸组（n = 51）的患者特征相似。负压抽吸组的全因并发症发生率更高（5例 vs. 0例；P = 0.03）：气胸（n = 3）、手术治疗的血胸并随后死亡（n = 1）和复张性肺水肿导致呼吸衰竭（n = 1），操作提前终止率也是如此（8例 vs. 1例；P = 0.018）。负压抽吸组在引流期间疼痛更剧烈（P < 0.05），引流时间更短（P < 0.01），与引流量无关（P > 0.05），引流速度倒数更低（P≤0.01）。
尽管胸腔穿刺术期间负压抽吸所需时间较少，但与更高的并发症发生率、操作提前终止率以及更剧烈的疼痛相关。虽然需要更大规模的研究，但这项初步研究表明手动抽吸提供了更高的安全性和患者舒适度。
