三个因素对经胸针吸术诊断肺炎有效性的影响。

Zalacain R, Llorente J L, Gaztelurrutia L, Pijoan J I, Sobradillo V

Servicio de Neumología, Hospital de Cruces, Vizcaya, Spain.

Chest. 1995 Jan;107(1):96-100. doi: 10.1378/chest.107.1.96.

Prior antibiotic therapy, size of the infiltrate, and the person who performed the technique were the three factors that we studied to assess their influence on the effectiveness of transthoracic needle aspiration (TNA). Ninety-one patients with a diagnosis of severe bacterial pneumonia, who underwent TNA, have been included in the study. The technique was carried out with an ultrathin needle gauge 25 and without fluoroscopic control. A univariate (UA) and a multivariate statistical analysis were made. The sensitivity of TNA was 34.1%. Fifty-seven of 91 (62.6%) had received antibiotic therapy prior to TNA; sensitivity was higher in nontreated patients than in treated patients (p = 0.0033; UA). There were 34 patients with an infiltrate that was smaller than a lobe (MINLOB); 39 cases affected a complete lobe (LOB) and 18 more than one lobe (MAJLOB). The TNA sensitivity was higher in LOB cases than in MINLOB cases (p = 0.0004; UA) while when comparing LOB cases and MAJLOB cases, sensitivity was higher in the former (p = NS; UA). In 28 of 91 cases (30.8%), the TNA was performed by A (a trained physician who regularly carries out the technique) and in 63 of 91 cases (69.2%) by B (other physicians, 10 in our study, who sporadically perform the technique). The TNA sensitivity was higher when the technique was performed by A, although this difference was not significant; if we add negative TNA with leukocytes present in Gram stains (which would indicate that aspiration was done in the correct area) to positive TNA, the difference between A and B was higher (p = 0.0248). The multivariate statistical analysis confirmed that there are two variables that are independently connected to a positive TNA (prior antibiotic therapy and size of the infiltrate). As regards the variable "person who carries out the technique," a significant association with a positive TNA was not established, although the estimations we obtained show a possible clinical relevance.

我们研究了先前的抗生素治疗、浸润灶大小以及实施该技术的人员这三个因素，以评估它们对经胸针吸活检（TNA）有效性的影响。本研究纳入了91例诊断为重症细菌性肺炎且接受了TNA的患者。该技术使用25号超细针进行，且未进行荧光透视控制。进行了单变量（UA）和多变量统计分析。TNA的敏感性为34.1%。91例患者中有57例（62.6%）在TNA之前接受了抗生素治疗；未接受治疗的患者的敏感性高于接受治疗的患者（p = 0.0033；UA）。有34例患者的浸润灶小于一个肺叶（MINLOB）；39例累及一个完整肺叶（LOB），18例累及一个以上肺叶（MAJLOB）。LOB病例的TNA敏感性高于MINLOB病例（p = 0.0004；UA），而比较LOB病例和MAJLOB病例时，前者的敏感性更高（p =无统计学意义；UA）。91例病例中有28例（30.8%）的TNA由A（一位经常实施该技术的训练有素的医生）进行，91例病例中有6例（69.2%）由B（其他医生，本研究中有10名，他们偶尔实施该技术）进行。当由A实施该技术时，TNA的敏感性更高，尽管这种差异不显著；如果将革兰氏染色中存在白细胞的阴性TNA（这表明穿刺在正确区域进行）与阳性TNA相加，A和B之间的差异更大（p = 0.0248）。多变量统计分析证实，有两个变量与阳性TNA独立相关（先前的抗生素治疗和浸润灶大小）。关于“实施该技术的人员”这一变量，虽然我们获得的估计显示出可能的临床相关性，但未确立与阳性TNA的显著关联。