Muruganandan Sanjeevan, Mishra Eleanor, Singh Bhajan
Department of Respiratory Medicine, The Northern Hospital, Melbourne, Australia.
School of Medicine, Health Sciences, Dentistry, University of Melbourne, Melbourne, Australia.
Semin Respir Crit Care Med. 2023 Aug;44(4):502-508. doi: 10.1055/s-0043-1769098. Epub 2023 Jun 12.
Breathlessness is the most common symptom in individuals with pleural effusion and is often disabling. The pathophysiology of breathlessness associated with pleural effusion is complex. The severity of breathlessness correlates weakly with the size of the effusion. Improvements in ventilatory capacity following pleural drainage are small and correlate poorly with the volume of fluid drained and improvements in breathlessness. Impaired hemidiaphragm function and a compensatory increase in respiratory drive to maintain ventilation appear to be an important mechanism of breathlessness associated with pleural effusion. Thoracocentesis reduces diaphragm distortion and improves its movement; these changes appear to reduce respiratory drive and associated breathlessness by improving the neuromechanical efficiency of the diaphragm.
呼吸困难是胸腔积液患者最常见的症状，且常常使人丧失活动能力。与胸腔积液相关的呼吸困难的病理生理学机制很复杂。呼吸困难的严重程度与胸腔积液量的关联较弱。胸腔穿刺引流后通气能力的改善幅度较小，且与引流液量以及呼吸困难的改善情况相关性较差。半侧膈肌功能受损以及为维持通气而出现的呼吸驱动代偿性增加似乎是与胸腔积液相关的呼吸困难的重要机制。胸腔穿刺术可减少膈肌变形并改善其运动；这些变化似乎通过提高膈肌的神经机械效率来降低呼吸驱动及相关的呼吸困难。
