Lan R S, Lo S K, Chuang M L, Yang C T, Tsao T C, Lee C H
Chang Gung Medical College, Taipei, Taiwan.
Ann Intern Med. 1997 May 15;126(10):768-74. doi: 10.7326/0003-4819-126-10-199705150-00003.
In patients who have malignant pleural effusion, it is difficult to diagnose trapped lung before thoracoscopy, thoracostomy, and drainage of the effusion. Predicting the outcome of pleurodesis in patients who have malignant pleural effusion without trapped lung is also difficult.
To investigate the factors that may be useful in diagnosing trapped lung and predicting the outcome of pleurodesis.
Prospective cohort study.
University medical center.
65 patients with symptomatic malignant pleural effusion.
A chest tube was inserted for drainage of the effusion, and pleurodesis was done using bleomycin as the sclerosant.
The pH and glucose levels of the effusion and the elastance of the pleural space (defined as the decline in pleural fluid pressure in cm H2O after removal of 500 mL of effusion) were measured. The outcome of pleurodesis was evaluated 1 month after the chest tube was removed.
Patients with an elastance of 19 cm H2O or more had a higher incidence of trapped lung (11 of 14 patients) than did those with an elastance less than 19 cm H2O (3 of 51 patients) (P < 0.001). None of the 14 patients with an elastance of 19 cm H2O or more and none of the 14 patients with a trapped lung had successful pleurodesis. Forty-two of 43 patients with an elastance less than 19 cm H2O who did not have a trapped lung had successful pleurodesis. Elastance seemed to be the best predictor for trapped lung and outcome of pleurodesis, although outcome was also correlated with pH and glucose levels of the effusion. Low-dose bleomycin (30 mg) is as effective as the usual dose of bleomycin (60 mg) for pleurodesis.
In patients with symptomatic malignant pleural effusion, measurement of the elastance of the pleural space is a simple and effective method for the diagnosis of trapped lung and prediction of the outcome of chemical pleurodesis with bleomycin.
在恶性胸腔积液患者中，在胸腔镜检查、胸腔造口术及胸腔积液引流之前，很难诊断出肺被陷闭。预测无肺被陷闭的恶性胸腔积液患者胸膜固定术的结果也很困难。
研究可能有助于诊断肺被陷闭及预测胸膜固定术结果的因素。
前瞻性队列研究。
大学医学中心。
65例有症状的恶性胸腔积液患者。
插入胸腔引流管引流胸腔积液，并使用博来霉素作为硬化剂进行胸膜固定术。
测量胸腔积液的pH值和葡萄糖水平以及胸膜腔弹性（定义为抽出500 mL胸腔积液后胸腔内压力下降的厘米水柱数）。在拔除胸腔引流管1个月后评估胸膜固定术的结果。
弹性≥19 cmH₂O的患者中肺被陷闭的发生率（14例中的11例）高于弹性＜19 cmH₂O的患者（51例中的3例）（P＜0.001）。弹性≥19 cmH₂O的14例患者及有肺被陷闭的14例患者中均无胸膜固定术成功。弹性＜19 cmH₂O且无肺被陷闭的43例患者中有42例胸膜固定术成功。弹性似乎是肺被陷闭及胸膜固定术结果的最佳预测指标，尽管结果也与胸腔积液的pH值和葡萄糖水平相关。低剂量博来霉素（30 mg）用于胸膜固定术与常规剂量博来霉素（60 mg）效果相同。
对于有症状的恶性胸腔积液患者，测量胸膜腔弹性是诊断肺被陷闭及预测博来霉素化学性胸膜固定术结果的一种简单有效的方法。
