Brandstetter R D, Karetzky M, Rastogi R, Lolis J D
New Rochelle Hospital Medical Center, New Rochelle, N.Y.
Heart Lung. 1994 Jan-Feb;23(1):67-70.
To determine whether the frequency of pneumothorax is increased after thoracentesis in chronic obstructive pulmonary disease patients.
Prospective.
Northeastern community hospital.
One-hundred-six patients underwent multiple thoracentesis; 36 patients had co-existent chronic obstructive pulmonary disease (mean age, 68.2 years). Chronic obstructive pulmonary disease was identified by radiologic findings consistent with chronic obstructive pulmonary disease and as forced expiratory volume in one second less than 70% of predicted.
Identification of pneumothorax on chest roentgenogram after thoracentesis.
Patients had diagnostic or therapeutic thoracentesis with follow-up chest radiography within 2 hours, or sooner if clinically indicated.
Patients with chronic obstructive pulmonary disease had a higher incidence of pneumothorax (15 of 36 patients; 41.7%) than those patients without underlying chronic obstructive pulmonary disease (13 of 70 patients; 18.5%; p = 0.005). The frequency of pneumothorax was no different according to who performed the procedure (house staff or pulmonologist), whether it was for diagnostic or therapeutic reasons, and whether a small (< 500 ml) or large (> 500 ml) amount of fluid is removed.
Pneumothorax may frequently occur in patients with chronic obstructive pulmonary disease undergoing thoracentesis. The reason may be related to the altered architecture of the lung parenchyma and the change in mechanical forces in chronic obstructive pulmonary disease. Sonography-guided thoracentesis may offer a safer means of performing thoracentesis in patients with chronic obstructive pulmonary disease.
确定慢性阻塞性肺疾病患者胸腔穿刺术后气胸发生率是否增加。
前瞻性研究。
东北社区医院。
106例患者接受了多次胸腔穿刺术；36例患者同时患有慢性阻塞性肺疾病（平均年龄68.2岁）。根据与慢性阻塞性肺疾病相符的放射学表现及一秒用力呼气量低于预测值的70%来确定慢性阻塞性肺疾病。
胸腔穿刺术后胸部X线片上气胸的识别。
患者接受诊断性或治疗性胸腔穿刺术，并在2小时内进行胸部X线片随访，如有临床指征则更快进行。
慢性阻塞性肺疾病患者气胸发生率（36例患者中的15例；41.7%）高于无潜在慢性阻塞性肺疾病的患者（70例患者中的13例；18.5%；p = 0.005）。气胸发生率与操作者（住院医师或肺科医生）、穿刺目的是诊断性还是治疗性以及抽取液体量少（<500 ml）或多（>500 ml）无关。
慢性阻塞性肺疾病患者在接受胸腔穿刺术时可能频繁发生气胸。原因可能与慢性阻塞性肺疾病中肺实质结构改变和机械力变化有关。超声引导下胸腔穿刺术可能为慢性阻塞性肺疾病患者提供一种更安全的胸腔穿刺方法。
