Gervais D A, Petersein A, Lee M J, Hahn P F, Saini S, Mueller P R
Department of Radiology, Children's Hospital, Boston, Mass, USA.
Radiology. 1997 Aug;204(2):503-6. doi: 10.1148/radiology.204.2.9240544.
To identify a population of patients who may not need chest radiography after diagnostic thoracentesis by assessing and comparing the pneumothorax rates in patients with mechanical ventilation (intubation) versus spontaneously breathing patients (no intubation).
A retrospective review of all radiographs, clinical records, and ultrasound (US) scans obtained in 434 patients who underwent US-guided thoracentesis was performed. Three hundred forty-two patients were not intubated and 92 were intubated. Nine patients were excluded because of preexisting pneumothorax. The size of the effusion, the needle size used, and whether a pneumothorax occurred after the procedure were determined.
Results demonstrated that only 10 pneumothoraces occurred (six in intubated and four in nonintubated patients). None of the nonintubated patients with pneumothorax and two of the six intubated patients with pneumothorax needed chest tubes. The difference in the pneumothorax rate between intubated and nonintubated patients was statistically significant (P < .01).
Spontaneously breathing patients who undergo diagnostic thoracentesis do not need postprocedure chest radiography.
通过评估和比较机械通气（插管）患者与自主呼吸患者（未插管）气胸发生率，确定诊断性胸腔穿刺术后可能无需进行胸部X线检查的患者群体。
对434例行超声引导下胸腔穿刺术患者的所有X线片、临床记录和超声扫描进行回顾性分析。342例患者未插管，92例患者插管。9例因既往存在气胸被排除。确定胸腔积液大小、所用穿刺针规格以及术后是否发生气胸。
结果显示仅发生10例气胸（插管患者6例，未插管患者4例）。未插管气胸患者均无需放置胸管，插管气胸患者中有2例需要放置胸管。插管患者与未插管患者气胸发生率差异有统计学意义（P <.01）。
接受诊断性胸腔穿刺术的自主呼吸患者术后无需进行胸部X线检查。
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