Seneff M G, Corwin R W, Gold L H, Irwin R S
Chest. 1986 Jul;90(1):97-100. doi: 10.1378/chest.90.1.97.
In order to determine the spectrum and frequency of complications associated with thoracocentesis, we decided to audit prospectively all thoracocentesis performed in the medical service at our institution. Over a ten-month interval, 125 procedures were performed. We identified 114 (91 percent) prospectively, 11 retrospectively by a computer-assisted review of discharge summaries. Forty-six percent of the procedures were complicated by at least one adverse occurrence. Complications considered major occurred in 14 percent, minor in 33 percent. The major complications included 14 pneumothoraces (three required tube thoracostomies and one percutaneous aspiration), one splenic laceration, one sheared-off catheter, and one pneumohemothorax. The minor complications included pain in 28, persistent cough in 14, dry taps in 16, and subcutaneous fluid collections in four patients. We conclude that thoracocentesis can carry the risk of frequent morbidity even when a lecture and printed guidelines on performing thoracocentesis have been given and experienced individuals are in attendance during the performance of the procedure. Our study suggests a portion of this morbidity may be from poor technique, inability to adequately identify landmarks, and improper utilization of a needle-catheter apparatus. Suggestions for correction of these problems are made.
为了确定与胸腔穿刺术相关的并发症的范围和发生率，我们决定对在我们机构内科进行的所有胸腔穿刺术进行前瞻性审核。在十个月的时间里，共进行了125例手术。我们前瞻性地识别出114例（91%），通过计算机辅助回顾出院小结又回顾性地识别出11例。46%的手术至少出现了一种不良事件。严重并发症发生率为14%，轻微并发症发生率为33%。严重并发症包括14例气胸（3例需要进行胸腔闭式引流术，1例需要经皮抽吸）、1例脾破裂、1例导管折断和1例血气胸。轻微并发症包括28例疼痛、14例持续性咳嗽、16例干抽以及4例皮下积液。我们得出结论，即使在进行胸腔穿刺术之前已进行了相关讲座并发放了操作指南，且手术过程中有经验丰富的人员在场，胸腔穿刺术仍可能频繁导致发病。我们的研究表明，部分发病可能源于技术欠佳、无法充分识别体表标志以及对针导管装置使用不当。针对这些问题提出了纠正建议。
