胸腔积液引流在 ICU 中的应用：一项更新的系统评价和荟萃分析。

Utility of pleural effusion drainage in the ICU: An updated systematic review and META-analysis.

机构信息

Division of Anesthesia and Intensive Care Medicine, Department of Medicine, University of Udine, P.le S. Maria della Misericordia 15, 33100 Udine, Italy.

Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy.

出版信息

J Crit Care. 2019 Aug;52:22-32. doi: 10.1016/j.jcrc.2019.03.007. Epub 2019 Mar 19.

DOI:10.1016/j.jcrc.2019.03.007

PMID:30951925

Abstract

PURPOSE

The effects on the respiratory or hemodynamic function of drainage of pleural effusion on critically ill patients are not completely understood. First outcome was to evaluate the PiO/FiO (P/F) ratio before and after pleural drainage.

SECONDARY OUTCOMES

evaluation of A-a gradient, End-Expiratory lung volume (EELV), heart rate (HR), mean arterial pressure (mAP), left ventricular end-diastolic volume (LVEDV), stroke volume (SV), cardiac output (CO), ejection fraction (EF), and E/A waves ratio (E/A). A tertiary outcome: evaluation of pneumothorax and hemothorax complications.

MATERIALS AND METHODS

Searches were performed on MEDLINE, EMBASE, COCHRANE LIBRARY, SCOPUS and WEB OF SCIENCE databases from inception to June 2018 (PROSPERO CRD42018105794).

RESULTS

We included 31 studies (2265 patients). Pleural drainage improved the P/F ratio (SMD: -0.668; CI: -0.947-0.389; p < .001), EELV (SMD: -0.615; CI: -1.102-0.219; p = .013), but not A-a gradient (SMD: 0.218; CI: -0.273-0.710; p = .384). HR, mAP, LVEDV, SV, CO, E/A and EF were not affected. The risks of pneumothorax (proportion: 0.008; CI: 0.002-0.014; p = .138) and hemothorax (proportion: 0.006; CI: 0.001-0.011; p = .962) were negligible.

CONCLUSIONS

Pleural effusion drainage improves oxygenation of critically ill patients. It is a safe procedure. Further studies are needed to assess the hemodynamic effects of pleural drainage.

摘要

目的

目前对于大量胸腔积液引流对危重症患者呼吸和血流动力学功能的影响尚不完全清楚。本研究的首要结局是评估胸腔引流前后的氧合指数（PaO2/FiO2，P/F）比值。次要结局为评估肺泡-动脉氧分压差（A-a 梯度）、呼气末肺容积（EELV）、心率（HR）、平均动脉压（mAP）、左心室舒张末期容积（LVEDV）、每搏量（SV）、心输出量（CO）、射血分数（EF）和 E/A 波比值。第三个结局是评估气胸和血胸并发症。

材料和方法

检索 MEDLINE、EMBASE、COCHRANE 图书馆、SCOPUS 和 WEB OF SCIENCE 数据库，检索时间为 2018 年 6 月之前（PROSPERO CRD42018105794）。

结果

共纳入 31 项研究（2265 例患者）。胸腔引流可改善 P/F 比值（SMD：-0.668；95%CI：-0.947-0.389；p<0.001）和 EELV（SMD：-0.615；95%CI：-1.102-0.219；p=0.013），但对 A-a 梯度无影响（SMD：0.218；95%CI：-0.273-0.710；p=0.384）。HR、mAP、LVEDV、SV、CO、E/A 和 EF 无明显变化。气胸（比例：0.008；95%CI：0.002-0.014；p=0.138）和血胸（比例：0.006；95%CI：0.001-0.011；p=0.962）的风险较小。