Zielinska-Krawczyk Monika, Stecka Anna M, Grabczak Elzbieta M, Michnikowski Marcin, Zieliński Krzysztof, Korczynski Piotr, Gólczewski Tomasz, Krenke Rafal
Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
Pol Arch Intern Med. 2022 Apr 28;132(4). doi: 10.20452/pamw.16185. Epub 2022 Jan 4.
Therapeutic thoracentesis is highly effective in providing symptomatic improvement in patients with large volume pleural effusion (PE). However, some physiological effects of pleural fluid (PF) withdrawal are still not fully elucidated.
The study aimed to evaluate alterations in the breathing pattern, pulmonary function, and arterial blood gases (ABG) in relation to both withdrawn PF volume and pleural pressure (Ppl) changes in patients undergoing therapeutic thoracentesis.
This prospective, observational, cross‑sectional study included 37 patients with large volume PE. Respiratory rate (RR), dyspnea, pulmonary function, and ABG were assessed before the thoracentesis, at the termination of the PF withdrawal and 1, 3, and 24 hours after the procedure. The volume of PF drained, Ppl, and tidal volume (TV) were monitored during the thoracentesis.
Thoracentesis resulted in a transient but significant increase in RR directly after the procedure, and a transient decrease, followed by subsequent increase in TV. There was a significant and constant increase in forced vital capacity up to 24 hours after thoracentesis (P = 0.001). Oxygen partial pressure (PaO2) significantly improved directly after PF withdrawal (P = 0.01) and returned to baseline values after 24 hours. Thoracentesis was invariably associated with a significant increase in the amplitude of Ppl (Ppl_ampl) changes during the respiratory cycle (P <0.001).
Therapeutic thoracentesis results in a modest improvement in pulmonary function, tran-sient increase in PaO2 and increase in Ppl_ampl. The improvement in pulmonary function and ABG is closely related to the volume of PF drained and pleural elastance. The increase in Ppl_ampl probably represents a more efficient work of the respiratory muscles.
治疗性胸腔穿刺术在改善大量胸腔积液（PE）患者的症状方面非常有效。然而，胸腔积液（PF）抽取的一些生理效应仍未完全阐明。
本研究旨在评估治疗性胸腔穿刺术患者的呼吸模式、肺功能和动脉血气（ABG）与抽取的PF量和胸膜压力（Ppl）变化之间的关系。
这项前瞻性、观察性、横断面研究纳入了37例大量PE患者。在胸腔穿刺术前、PF抽取结束时以及术后1、3和24小时评估呼吸频率（RR）、呼吸困难、肺功能和ABG。在胸腔穿刺术期间监测引流的PF量、Ppl和潮气量（TV）。
胸腔穿刺术后RR立即出现短暂但显著的增加，TV短暂下降，随后增加。胸腔穿刺术后24小时内用力肺活量持续显著增加（P = 0.001）。PF抽取后氧分压（PaO2）显著改善（P = 0.01），24小时后恢复到基线值。胸腔穿刺术总是与呼吸周期中Ppl变化幅度（Ppl_ampl）的显著增加相关（P <0.001）。
治疗性胸腔穿刺术可使肺功能适度改善，PaO2短暂升高，Ppl_ampl增加。肺功能和ABG的改善与引流的PF量和胸膜弹性密切相关。Ppl_ampl的增加可能代表呼吸肌更有效的工作。
