Alkrinawi S, Chernick V
Section of Pediatric Respirology, Children's Hospital of Winnipeg, Manitoba, Canada.
Semin Respir Infect. 1996 Sep;11(3):148-54.
The physiology of pleural liquid formation and stages of pleural effusion are reviewed in this article in our recent experience, only 50% of pleural effusions in hospitalized patients were parapneumonic and only about 7% of these patients could be classified as having an empyema. These findings are in contrast to children 20 to 30 years ago in whom over 40% of parapneumonic effusions were empyemas. Diagnostic approaches are also controversial. The accuracy, sensitivity and specificity of various biochemical tests of pleural fluid have not been assessed in children. It seems reasonable to avoid thoracentesis if the clinician is certain of etiology of the pleural effusion from the history, physical examination, and supporting laboratory data. Treatment is also controversial. Indeed, most patients recover without tube thoracostomy. In our series, only 27% of patients were treated with tube drainage. It is suggested that drainage is necessary to relieve respiratory difficulty or pleuritic pain when effusions are relatively large. The need to drain all empyemas is also a controversial issue both in the child and adult. Clearly, what is needed is a carefully designed multicentered prospective study of pleural effusion in children.
本文回顾了胸腔积液形成的生理学及胸腔积液的阶段。根据我们最近的经验，住院患者中只有50%的胸腔积液是肺炎旁胸腔积液，其中只有约7%的患者可归类为脓胸。这些发现与20至30年前的儿童情况形成对比，当时超过40%的肺炎旁胸腔积液是脓胸。诊断方法也存在争议。各种胸腔积液生化检查的准确性、敏感性和特异性尚未在儿童中进行评估。如果临床医生根据病史、体格检查和辅助实验室数据确定胸腔积液的病因，避免胸腔穿刺似乎是合理的。治疗也存在争议。事实上，大多数患者未经胸腔闭式引流即可康复。在我们的系列研究中，只有27%的患者接受了胸腔引流治疗。当积液相对较大时，建议进行引流以缓解呼吸困难或胸痛。对于儿童和成人，是否需要引流所有脓胸也是一个有争议的问题。显然，需要开展一项精心设计的关于儿童胸腔积液的多中心前瞻性研究。
