Jarratt M J, Sahn S A
Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston 29425, USA.
Chest. 1995 Aug;108(2):470-4. doi: 10.1378/chest.108.2.470.
To determine the incidence, causes, and clinical features of pleural effusions in hospitalized patients receiving long-term hemodialysis.
Retrospective.
One hundred patients receiving hemodialysis for at least 3 months with pleural effusion hospitalized at the Medical University of South Carolina hospitals.
The incidence of pleural effusions in hospitalized patients receiving long-term hemodialysis was 21%. The mean (+/- SEM) age was 55 +/- 1.4 years and the male to female and black to white ratios were 3:2. Pleural effusions resulted from heart failure in 46% and nonheart failure causes in 54%. Uremic pleurisy (n = 16), parapneumonic effusion (n = 15), and atelectasis (n = 11) accounted for most of the nonheart failure causes of pleural effusions. Three of 15 (20%) parapneumonic effusions were empyemas. The presence of chest pain was not different in patients with parapneumonic effusions than in other patients with nonheart failure effusion (all p = NS) but was more frequent compared to those with heart failure (p = 0.006). Patients with parapneumonic effusions (p = 0.0006) and atelectasis (p = 0.003) were more likely to have unilateral pleural effusions than patients with heart failure.
Pleural effusions are common in hospitalized patients receiving chronic hemodialysis. Although heart failure was the most common cause, other diseases were responsible for most of the effusions. The presence of a unilateral effusion suggests a diagnosis other than heart failure, most commonly parapneumonic effusion or atelectasis and deserves prompt thoracentesis as these effusions often cannot be reliably differentiated clinically. The reduced humoral and cellular immunity, in addition to delay in diagnosis because of an attenuated clinical response, may explain the high rate of empyemas in this study population.
确定接受长期血液透析的住院患者胸腔积液的发生率、病因及临床特征。
回顾性研究。
100例在南卡罗来纳医科大学医院住院、接受血液透析至少3个月且伴有胸腔积液的患者。
接受长期血液透析的住院患者胸腔积液的发生率为21%。平均（±标准误）年龄为55±1.4岁，男女比例为3:2，黑种人与白种人比例为3:2。胸腔积液由心力衰竭引起的占46%，非心力衰竭原因引起的占54%。尿毒症胸膜炎（n = 16）、肺炎旁胸腔积液（n = 15）和肺不张（n = 11）是胸腔积液非心力衰竭原因的主要构成。15例肺炎旁胸腔积液中有3例（20%）为脓胸。肺炎旁胸腔积液患者胸痛的发生率与其他非心力衰竭性胸腔积液患者无差异（所有p值均无统计学意义），但与心力衰竭患者相比更常见（p = 0.006）。与心力衰竭患者相比，肺炎旁胸腔积液患者（p = 0.0006）和肺不张患者（p = 0.003）更易出现单侧胸腔积液。
胸腔积液在接受慢性血液透析的住院患者中很常见。虽然心力衰竭是最常见的病因，但其他疾病导致了大多数胸腔积液。单侧胸腔积液提示可能不是心力衰竭，最常见的是肺炎旁胸腔积液或肺不张，鉴于这些胸腔积液往往无法通过临床可靠鉴别，故值得及时进行胸腔穿刺术。除了因临床反应减弱导致诊断延迟外，体液和细胞免疫降低可能解释了本研究人群中脓胸的高发生率。
