Department of Medicine, Division of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY.
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY.
Chest. 2020 Feb;157(2):421-426. doi: 10.1016/j.chest.2019.08.1920. Epub 2019 Aug 28.
Both elevated pleural elastance (E-P) and radiographic evidence of incomplete lung expansion following thoracentesis have been used to exclude patients with a malignant pleural effusion (MPE) from undergoing pleurodesis. This article reports on a cohort of patients with MPE in whom complete drainage was attempted with pleural manometry to determine the frequency of E-P and its relation with postthoracentesis radiographic findings.
Seventy consecutive patients with MPE who underwent therapeutic pleural drainage with pleural manometry were identified. The pressure/volume curves were constructed and analyzed to determine the frequency of E-P and the relation of P to the postthoracentesis chest radiographic findings.
E-P and incomplete lung expansion were identified in 36 of 70 (51.4%) and 38 of 70 (54%) patients, respectively. Patients with normal P had an OR of 6.3 of having complete lung expansion compared with those with E-P (P = .0006). However, 20 of 70 (29%) patients exhibited discordance between postprocedural chest radiographic findings and the pleural manometry results. Among patients who achieved complete lung expansion on the postdrainage chest radiograph, 9 of 32 (28%) had an E-P. In addition, P was normal in 11 of 38 (34%) patients who had incomplete lung expansion as detected according to the postthoracentesis chest radiograph.
E-P and incomplete lung expansion postthoracentesis are frequently observed in patients with MPE. Nearly one-third of the cohort exhibited discordance between the postprocedural chest radiographic findings and pleural manometry results. These findings suggest that a prospective randomized trial should be performed to compare both modalities (chest radiograph and pleural manometry) in predicting pleurodesis outcome.
在进行胸腔穿刺术之后，升高的胸膜弹性（E-P）和不完全的肺膨胀的放射学证据都被用于排除患有恶性胸腔积液（MPE）的患者进行胸膜固定术。本文报告了一组 MPE 患者的队列，他们通过胸膜测压来尝试完全引流，以确定 E-P 的频率及其与胸腔穿刺后放射学表现的关系。
确定了 70 例连续接受 MPE 治疗性胸腔引流和胸膜测压的患者。构建和分析压力/容量曲线，以确定 E-P 的频率以及 P 与胸腔穿刺后胸部放射学表现的关系。
E-P 和不完全的肺膨胀分别在 70 例患者中的 36 例（51.4%）和 38 例（54%）中被发现。与 E-P 患者相比，P 值正常的患者完全肺膨胀的 OR 为 6.3（P =.0006）。然而，20 例患者（29%）的胸腔穿刺后胸部放射学表现与胸膜测压结果之间存在不一致。在胸腔引流后胸部 X 线片上完全肺膨胀的患者中，9 例（28%）存在 E-P。此外，根据胸腔穿刺后胸部 X 线片，38 例不完全肺膨胀患者中有 11 例（34%）P 值正常。
E-P 和胸腔穿刺术后不完全的肺膨胀在 MPE 患者中经常观察到。将近三分之一的队列表现出胸腔穿刺后胸部放射学表现和胸膜测压结果之间的不一致。这些发现表明，应该进行前瞻性随机试验，比较两种方法（胸部 X 线片和胸膜测压）在预测胸膜固定术结果方面的效果。
