Qureshi N, Momin Z A, Brandstetter R D
Department of Medicine, New Rochelle Hospital Medical Center, NY 10802.
Heart Lung. 1994 Sep-Oct;23(5):376-83.
Thoracentesis is a commonly performed procedure indicated for diagnostic and therapeutic purposes. Removal of pleural fluid should be performed by experienced operators and, when attempted by physicians-in-training, close supervision by credentialed individuals is necessary. Diagnostic thoracentesis is most valuable in separating exudates from transudates. Analysis of the exudative fluid has the highest yield when infection and malignancy is likely. Pneumothorax is the most common major complication and can be minimized by the use of small-gauge needles (no. 21 or no. 22) when a small amount of fluid is removed (35 to 50 ml). Patients who may pose difficulties (e.g., those receiving ventilator support) appear to have no greater morbidity with thoracentesis than those patients not ventilator dependent. Ultrasound may be of value to decrease morbidity when small or loculated volumes of fluid are present. Therapeutic thoracentesis offers relief of symptoms of dyspnea, but caution is particularly needed because large needles and large volumes of fluid removed may increase morbidity.
胸腔穿刺术是一种常用于诊断和治疗目的的操作。胸腔积液的抽取应由经验丰富的操作人员进行，当实习医生尝试操作时，必须有具备资质的人员进行密切监督。诊断性胸腔穿刺术在区分渗出液和漏出液方面最具价值。当可能存在感染和恶性肿瘤时，对渗出液进行分析的阳性率最高。气胸是最常见的主要并发症，当抽取少量液体（35至50毫升）时，使用小号针头（21号或22号）可将其风险降至最低。可能存在困难的患者（如接受呼吸机支持的患者）进行胸腔穿刺术时的发病率似乎并不高于非呼吸机依赖患者。当存在少量或局限性积液时，超声检查可能有助于降低发病率。治疗性胸腔穿刺术可缓解呼吸困难症状，但需特别谨慎，因为使用大针头和抽取大量液体可能会增加发病率。
