Mattison L E, Coppage L, Alderman D F, Herlong J O, Sahn S A
Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston 29425, USA.
Chest. 1997 Apr;111(4):1018-23. doi: 10.1378/chest.111.4.1018.
To determine the prevalence and causes of pleural effusions in patients admitted to a medical ICU (MICU).
Prospective.
MICU in a tertiary care hospital.
One hundred consecutive patients admitted to the MICU at the Medical University of South Carolina whose length of stay exceeded 24 h had chest radiographs reviewed daily and chest sonograms performed within 10 h of their latest chest radiograph.
The prevalence of pleural effusions in 100 consecutive MICU patients was 62%, with 41% of effusions detected at admission. Fifty-seven of 62 (92%) pleural effusions were small. Causes of pleural effusions were as follows: heart failure, 22 of 62 (35%); atelectasis, 14 of 62 (23%); uncomplicated parapneumonic effusions, seven of 62 (11%); hepatic hydrothorax, five of 62 (8%); hypoalbuminemia, five of 62 (8%); malignancy, two of 62 (3%); and unknown, three of 62 (5%). Pancreatitis, extravascular catheter migration, uremic pleurisy, and empyema caused an effusion in one instance each. Heart failure was the most frequent cause of bilateral effusions (13/34 [38%]). When compared with patients who never had effusions during their MICU stay, patients with pleural effusions were older (54+/-2 years, mean+/-SEM, vs 47+/-2 years [p=0.04]), had lower serum albumin concentration (2.4+/-0.1 vs 3.0+/-0.01 g/dL [p=0.002]), higher acute physiology and chronic health evaluation II scores during the initial 24 h of MICU stay (17.2+/-1.1 vs 12+/-1.2 [p=0.010]), longer MICU stays (9.8+/-1.0 vs 4.6+/-0.7 days [p=0.0002]), and longer mechanical ventilation (7.0+/-1.3 vs 1.9+/-0.7 days [p=0.004]). No patient died as a direct result of his or her pleural effusion. Chest radiograph readings had good correlation with chest sonograms (p<0.0001).
Pleural effusions in MICU patients are common, and most are detected by careful review of chest radiographs taken with the patient in erect or semierect position. When clinical suspicion for infection is low, observation of these effusions is warranted initially, because most are caused by noninfectious processes that should improve with treatment of the underlying disease.
确定入住内科重症监护病房（MICU）患者胸腔积液的患病率及病因。
前瞻性研究。
一所三级医疗中心的MICU。
南卡罗来纳医科大学MICU连续收治的100例住院时间超过24小时的患者，每天复查胸部X线片，并在最近一次胸部X线片后10小时内进行胸部超声检查。
100例连续入住MICU的患者中胸腔积液的患病率为62%，其中41%的积液在入院时被发现。62例胸腔积液中有57例（92%）为少量积液。胸腔积液的病因如下：心力衰竭，62例中有22例（35%）；肺不张，62例中有14例（23%）；单纯性肺炎旁胸腔积液，62例中有7例（11%）；肝性胸水，62例中有5例（8%）；低蛋白血症，62例中有5例（8%）；恶性肿瘤，62例中有2例（3%）；原因不明，62例中有3例（5%）。胰腺炎、血管外导管移位、尿毒症胸膜炎和脓胸各导致1例胸腔积液。心力衰竭是双侧胸腔积液最常见的原因（13/34 [38%]）。与在MICU住院期间从未发生过胸腔积液的患者相比，发生胸腔积液的患者年龄更大（平均54±2岁，标准差±标准误，vs 47±2岁 [p = 0.04]），血清白蛋白浓度更低（2.4±0.1 vs 3.0±0.01 g/dL [p = 0.002]），MICU住院最初24小时内急性生理与慢性健康状况评分II更高（17.2±1.1 vs 12±1.2 [p = 0.010]），MICU住院时间更长（9.8±1.0 vs 4.6±0.7天 [p = 0.0002]），机械通气时间更长（7.0±1.3 vs 1.9±0.7天 [p = 0.004]）。没有患者因胸腔积液直接死亡。胸部X线片读数与胸部超声检查有良好的相关性（p < 0.0001）。
MICU患者胸腔积液很常见，大多数通过仔细复查患者直立或半直立位时拍摄的胸部X线片发现。当临床感染怀疑度较低时，最初应对这些积液进行观察，因为大多数是由非感染性过程引起的，随着基础疾病的治疗应会改善。
