心理干预对胸穿抽液患者应激反应的影响

目的探讨心理干预对胸穿抽液患者应激反应的影响。方法将拟行胸穿抽液的110例患者随机分为对照组和实验组,各55例。对照组接受常规操作和护理,实验组在此基础上实施全程心理干预。观察2组胸穿前后的血压、心率、去甲肾上腺素、肾上腺素和皮质醇变化。结果2组相比,实验组胸穿前后的收缩压和心率均低于对照组,差异有统计学意义(p<0.05),实验组胸穿后的血清去甲肾上腺素、肾上腺素与皮质醇水平低于对照组,差异有统计学意义(p<0.05)。结论在胸穿抽液治疗过程中,实施全程心理干预,可明显减轻胸穿抽液所致应激反应。     

双腔深静脉导管胸腔置入治疗胸腔积液的临床分析

目的探讨双腔深静脉导管胸腔置入治疗胸腔积液的临床应用的方法及效果。方法将中至大量的胸腔积液的患者56例,随机分为两组,分别为28例,治疗组为双腔深静脉导管胸腔置入组,对照组为传统的胸腔穿刺术组。结果 28例患者置管成功率达100%,其中保留过程中导管脱出1例,无1例患者出现血胸、气胸、胸膜炎严重并发症,患者整体耐受性良好,平均引流量、平均穿刺费用、平均住院天数,都优于对照组,临床效果显著。结论双腔深静脉导管胸腔置入操作简单,安全有效,优于常规穿刺抽液术,且安全性好。是治疗中等量以上胸腔积液的方法之一。     

Hydrostatic mechanisms may contribute to the pathogenesis of human re-expansion pulmonary edema

Objective The primary objective was to test the hypothesis that clinical re-expansion pulmonary edema is predominantly due to increased permeability of the alveolar-capillary barrier. A secondary objective was to determine if the alveolar epithelium was functionally intact in patients with re-expansion pulmonary edema by measuring net alveolar epithelial fluid transport in a subset of patients.Design Retrospective study of mechanically ventilated patients with re-expansion pulmonary edema.Setting Two academic tertiary care hospitals.Patients Seven patients with acute onset of re-expansion pulmonary edema after tube thoracostomy or thoracentesis.Interventions Pulmonary edema fluid and plasma were collected at the time of onset of re-expansion edema.Measurements and results Contrary to our hypothesis, the mean initial edema fluid to plasma protein ratio was 0.58±0.21, supporting a hydrostatic mechanism of edema formation. Four of the patients had an initial edema fluid to plasma protein ratio of less than 0.65, consistent with pure hydrostatic pulmonary edema, while the others had a slight increase in permeability (edema fluid to plasma ratios of 0.67, 0.71 and 0.77), perhaps due to capillary stress failure from hydrostatic stress. Alveolar fluid clearance (mean 9.8±8.0%/h) was intact in the subset of three patients in whom it was measured.Conclusions This study provides the first direct evidence that hydrostatic forces may contribute to the development of re-expansion pulmonary edema.This study was supported by NIH HL51856 (MAM) and NIH HL70521 (LBW)     

Cambios en los parámetros bioquímicos del líquido pleural entre 2 toracocentesis consecutivas para diferenciar derrames malignos de benignos

Objective

To assess whether changes in pleural fluid (PF) biochemistries between two consecutive thoracenteses enable clinicians to predict malignant or benign pleural effusions (PE).

中心静脉导管胸腔闭式引流治疗特重度烧伤并发胸腔积液疗效观察

目的对比观察中心静脉导管胸腔闭式引流与胸膜腔穿刺术治疗特重度烧伤并发胸腔积液的临床疗效。方法按照随机数表法将2012年2月至2017年12月湘潭市中心医院烧伤创疡整形科收治的36例特重度烧伤并发胸腔积液患者随机分为试验组(18例)与对照组(18例),其中试验组患者采用中心静脉导管胸腔闭式引流治疗胸腔积液,对照组患者采用胸膜腔穿刺术治疗胸腔积液,对比观察两组患者的呼吸困难改善持续时间、引流量及胸腔积液消退时间。结果试验组患者的呼吸困难改善持续时间为(6.00±0.56)d、引流量为(856.28±236.24)mL/d、胸腔积液消退时间为(6.50±0.32)d,对照组患者的呼吸困难改善持续时间为(1.50±0.24)d、引流量为(478.62±125.82)mL/d、胸腔积液消退时间为(10.50±0.31)d,两组患者呼吸困难改善持续时间、引流量及胸腔积液消退时间对比,P均0.05,差异具有统计学意义。结论中心静脉导管胸腔闭式引流治疗特重度烧伤并发胸腔积液,不仅可避免反复多次胸膜腔穿刺,减少相应并发症的发生,还可促进胸腔积液消退,缓解呼吸困难等症状,减轻患者痛苦,值得临床推广应用。     

胸腔穿刺抽液对肺换气功能影响的研究

本文对30例各种原因单侧、游离性、渗出性胸膜炎病人胸腔抽液前后不同时间血气及肺泡—动脉血氧分压差VA—aDO_2)进行自身对照研究。结果表明:抽液前PaO_2降低、A—aDO_2增大、PaCO_2及HCO_3~-降低、BE负值增大,与正常值比较有显著差异(P<0.001)。术后PaO_2逐渐升高,A—aDO_2相应减小,与术前比较有显著差异(P<0.001),但PaCO_2、HC0z_2~-及BE无明显改变。提示胸腔积液可以导致低氧血症及慢性呼吸性碱中毒,胸腔抽液能改善低氧血症,但不能有效纠正呼吸性碱中毒。     

肝硬化失代偿期合并肝性胸水30例临床观察

目的 探讨肝硬化失代偿期合并肝性胸水患者的临床特点.方法 回顾性分析失代偿期肝硬化并发胸水30例病人的临床资料.结果 肝性胸水临床表现主要为胸闷、气促、胸痛、呼吸困难、咳嗽和不明原因低热.胸水位于右侧24例(80.0%),左侧4例(13.3%),双侧2例(6.7%).中、大量胸水27例,少量胸水3例,所有病例皆合并腹水...     

Impact of large-volume thoracentesis on transpulmonary thermodilution–derived extravascular lung water in medical intensive care unit patients

Purpose

The purpose of this study was to investigate the impact of large-volume thoracentesis (> 1000 mL) on transpulmonary thermodilution (TPTD)–derived cardiopulmonary parameters with special regard to extravascular lung water index (EVLWI).

Materials and Methods

Retrospective analysis of a prospectively maintained database including TPTD measurements of patients treated in a medical intensive care unit of a German university hospital between January 2009 and September 2010. Data of 17 patients treated with large-volume thoracentesis were analyzed.

Results

A median of 1350 (25%-75% interquartile range [IQR], 1200-1590) mL of pleural fluid was removed. Extravascular lung water index was statistically significantly higher after thoracentesis compared with baseline (9.0 [IQR, 8.0-13.0] vs 8.0 [IQR, 7.0-13.0] mL/kg) (P = .039). Pulmonary vascular permeability index (PVPI) also increased significantly after thoracentesis (1.7 [IQR, 1.3-2.4] vs 1.4 [IQR, 1.1-2.1]) (P = .019). When determined 2 and 6 hours after thoracentesis, EVLWI and PVPI even further increased. Six hours after removal of pleural fluid, we observed a median EVLWI of 11.0 (IQR, 8.0-15.0) mL/kg (P = .048 compared with baseline) and a median PVPI of 2.0 (IQR, 1.5-2.7) (P = .040 compared with baseline).

Conclusions

Large-volume thoracentesis results in a statistically significant increase in TPTD-derived EVLWI. Because EVLWI was higher after removal of pleural fluid, we conclude that pleural effusions do not take part in single-indicator TPTD as a part of the pulmonary thermovolume and do not increase TPTD-derived EVLWI.     

重症监护病房56例胸腔积液相关情况的回顾性分析

目的:回顾性分析安贞医院急诊重症监护病房(EICU)中56例胸腔积液患者的特点及预后,评价对危重患者进行胸腔穿刺的必要性和安全性。方法:对比胸腔积液患者和无胸腔积液患者住院时间,住院费用及转归的差异;观察胸腔穿刺对诊断的影响及并发症。结果:2004年1月至2005年4月EICU收治患者328例,合并胸腔积液者56例,其中双侧积液30例,主要原因是心力衰竭和低蛋白血症,水负荷过重;单侧胸水26例,主要原因是肺癌和炎性胸腔积液。胸腔积液患者与无胸腔积液患者比较住院时间较长(P<0.05),住院费用较高(P<0.05),病死率无差异。34例行胸腔穿刺,其中10例与初步诊断不一致,误诊率29.4%。胸腔穿刺并发症少。结论:EICU中胸腔积液的发生率较高,出现胸腔积液延长住院时间,增加住院费用,但不影响病死率。