天津医药

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胸膜腔压力变化对胸膜固定术成功率的预测价值

高淑连1,张凯茹2,李月川3,朱亚茜4   

  1. 1. 天津医科大学研究生院
    2. 天津医大总医院呼吸科
    3. 天津市胸科医院
    4. 天津市胸科医院胸内科
  • 收稿日期:2009-07-28 修回日期:2009-09-16 出版日期:2010-03-15 发布日期:2010-03-15
  • 通讯作者: 高淑连

The Predictive Value of the Change in Pleural Pressure on the Success Rate of Pleurodesis

  • Received:2009-07-28 Revised:2009-09-16 Published:2010-03-15 Online:2010-03-15

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摘要： 摘要 目的 研究胸膜腔压力变化对化学性胸膜固定术成功率的预测价值。方法 单中心、开放试验设计。选择顽固性大量恶性胸腔积液患者，B超定位下行胸腔细管引流，分别于初始及引流1000ml积液时测定坐位时的胸膜腔压力，计算胸膜弹回率(坐位平均胸膜腔压力变化/引流液体的量)。待彻底引流胸水后查胸CT+病灶局部HRCT，明确肺内及脏、壁层胸膜的病变程度和范围，对符合纳入标准的患者以顺铂60mg加生理盐水50ml稀释后注入胸腔，闭管4小时后开放并持续引流。当引流量少于20ml/d连续3天以上，复查B超显示胸腔内无或仅少量液体时拔除引流管。观察4周胸水无复发为粘连成功，否则为失败。结果 72例顽固性恶性胸腔积液患者纳入本研究，胸膜固定术成功54例，失败18例。胸膜固定术成功的患者胸膜弹回率明显低于失败的患者（P<0.05），胸膜弹回率≥15cmH2O/L的患者胸膜固定术均失败，胸膜弹回率<15cmH2O/L的患者胸膜固定术成功率为86.10%，影像学存在不利于胸膜胸膜固定术成功表现的患者与不存在此表现的患者之间胸膜固定术成功率的差异无统计学意义（P>0.05）。结论 胸膜弹回率对化学性胸膜固定术的成功率具有重要的预测价值。

关键词: 胸膜腔压力, 胸膜弹回率, 胸膜固定术, 恶性胸腔积液

Abstract: Abstract Objective: To explore the prediction value of the change in pleural pressure on the success rate of pleurodesis.Methods: The research is single centre and open experimental designed.We selected patients with malignant pleural effusion.Under ultrasonographic guidance, an appropriate intercostal space was selected.Then the patients were conducted the thin tube d?rainage in the pleural cavity. The pleural pressure, defined as the mean pleural pressure, was measured immediately and after 1000mL of effusion was withdrawn. Measurements were done while patients were in a sitting position. The elastance of the pleural space was calculated as the change in pleural pressure (in cm H2O) divided by the amount of fluid removed.After the effusion was completely drained off,the chest CT and HRCT on the lesion was undergone to confirm the degree and range of the involved lungs,visceral and parietal pleura. Cisplatin was instilled into the pleural cavity.After clamping the tube for 4 hours,the pleural space was drained consecutively.The tube was removed when less than 20ml of effusion was drained per day for 3 consecutive days and no effusion or only little amount of fluid was shown on the ultrasound.The intervention was scored as “successful”if no fluid reaccumulation was noted at 4 weeks, otherwise,scored as “failure”. Result:The study contained 72 patients with malignant pleural effusion.The outcome of 54 patients was successful,the other 18 patients was failure. Pleural elastance of the “successful” patients was less then the “failure”(P<0.05).All of the patients whose pleural elastance was ≥15cmH2O/L have “failure” outcome.The success rate of pleurodesis was 86.10% on the patients whose pleural elastance was <15cmH2O/L.There was no statistically difference on the success rate of pleurodesis between no obvious changes and the significant changes on images(P>0.05).Conclusion:There was good predictive value of the pleural elastance on the success rate of pleurodesis.