Dorca J, Manresa F, Esteban L, Barreiro B, Prats E, Ariza J, Verdaguer R, Gudiol F
Servei de Pneumologia, Hospital de Bellvitge, Barcelona, Catalonia, Spain.
Am J Respir Crit Care Med. 1995 May;151(5):1491-6. doi: 10.1164/ajrccm.151.5.7735605.
In order to determine the potential indications of transthoracic needle aspiration (TNA) using the ultrathin 25G needle for the diagnosis of nonopportunistic lung infections, we prospectively analyzed the diagnostic efficacy, safety, and therapeutic implications of its results in 97 patients with nonventilated nosocomial pneumonias (NVNP). The sensitivity of TNA was 60.9%. Specificity and positive predictive value (PPV) were 100%. Negative predictive value (NPV) was 34.1%. The complications in the studied cases were nil in 89 cases (91.8%), transient hemoptoic expectoration (< 10 ml) in five (5.2%), and self-limited partial pneumothorax in three (3.1%). No complications needing treatment were observed. On the basis of a positive TNA result, the initial antibiotic treatment was modified in 29 of 97 (29.9%) cases. In twelve of these, the empirical antibiotic regimen was demonstrated to be ineffective. We conclude that, using the 25G needle, TNA has a good diagnostic efficacy and is a safe procedure for the etiologic investigation of NVNP. A positive TNA result has significant therapeutic relevance, even in cases where broad-spectrum antibiotics are empirically prescribed.
为了确定使用25G超薄针经胸针吸术（TNA）诊断非机会性肺部感染的潜在适应证，我们前瞻性分析了其对97例非通气型医院获得性肺炎（NVNP）患者的诊断效能、安全性及结果的治疗意义。TNA的敏感性为60.9%。特异性和阳性预测值（PPV）为100%。阴性预测值（NPV）为34.1%。在研究病例中，89例（91.8%）无并发症，5例（5.2%）出现短暂咯血痰（<10 ml），3例（3.1%）出现自限性局限性气胸。未观察到需要治疗的并发症。基于TNA阳性结果，97例中有29例（29.9%）患者的初始抗生素治疗方案得以调整。其中12例患者的经验性抗生素治疗方案被证明无效。我们得出结论，使用25G针进行TNA具有良好的诊断效能，是对NVNP进行病因学调查的安全方法。即使在经验性使用广谱抗生素的情况下，TNA阳性结果也具有显著的治疗意义。
