通过4种方法进行胸腔穿刺术:重力,手动抽吸,真空吸瓶,和墙壁吸力。本文献综述调查了这些技术的安全性,并确定并发症发生率是否存在显着差异。全面的文献检索显示了6篇研究胸腔穿刺术技术及其并发症发生率的文章,检查20,815例胸膜:80例(0.4%)重力,9431(45.3%)手动抽吸,3498(16.8%)通过真空瓶抽吸,7580(36.4%)由壁抽吸和226(1.1%)未指定。在6项研究中,2个较小,分别为100和140例患者。总的来说,有4.4%的并发症发生率,包括血胸,气胸,再扩张性肺水肿(REPE),胸部不适,部位出血,疼痛,和血管迷走性发作.气胸和REPE发生率为2.5%。按每种方法进行细分分析,重力组并发症发生率为47.5%(38/80),手动抽吸组为1.2%(115/9431),包括0.7%气胸或REPE,8%(285/3498)的真空瓶组,包括3.7%的气胸或REPE,4%(309/7580)在壁吸引组均为气胸或REPE,未指明组的73%(166/226),其中大部分为血管迷走发作.与重力引流相比,抽吸组的手术持续时间更短。两项较小的研究表明,在真空组中,呼吸衰竭导致的早期手术终止率明显高于非真空技术.通过任何技术进行胸腔穿刺术的显着并发症发生率都很低。注意到抽吸引流具有较低的手术时间。即使在大量引流的情况下,使用真空或壁抽吸,症状有限的胸腔穿刺术也是安全的。其他因素,如手术持续时间,去除的流体量,针通过的次数,患者BMI,与引流方式相比,操作员技术对并发症发生率的影响更大。所有引流的抽吸方式似乎都是安全的。运算符技术,注意症状发展,去除的液体量,和胸膜内压的变化可能是重要的预测并发症的发展,因此,在选择采用哪种技术时可能很有用。具体的引流方式及其并发症需要进一步研究。
Thoracentesis is performed by 4 methods: gravity, manual aspiration, vacuum-bottle suction, and wall suction. This literature
review investigates the safety of these techniques and determines if there is significant difference in complication rates. A comprehensive literature search revealed 6 articles studying
thoracentesis techniques and their complication rates, reviewing 20,815 thoracenteses: 80 (0.4%) by gravity, 9431 (45.3%) by manual aspiration, 3498 (16.8%) by vacuum-bottle suction, 7580 (36.4%) by wall suction and 226 (1.1%) unspecified. Of the 6 studies, 2 were smaller with 100 and 140 patients respectively. Overall, there was a 4.4% complication rate including hemothoraces, pneumothoraces, re-expansion pulmonary edema (REPE), chest discomfort, bleeding at the site, pain, and vasovagal episodes. The pneumothorax and REPE rate was 2.5%. Sub-analyzed by each method, there was a 47.5% (38/80) complication rate in the gravity group, 1.2% (115/9431) in the manual aspiration group including 0.7% pneumothorax or REPE, 8% (285/3498) in the vacuum-bottle group including 3.7% pneumothorax or REPE, 4% (309/7580) in the wall suction group all of which were either pneumothorax or REPE, and 73% (166/226) in the unspecified group most of which were vasovagal episodes. Procedure duration was less in the suction groups versus gravity drainage. The 2 smaller studies indicated that in the vacuum groups, early procedure termination rate from respiratory failure was significantly higher than non-vacuum techniques. Significant complication rate from
thoracentesis by any technique is low. Suction drainage was noted to have a lower procedure time. Symptom-limited
thoracentesis is safe using vacuum or wall suction even with large volumes drained. Other factors such as procedure duration, quantity of fluid removed, number of needle passes, patients\' BMI, and operator technique may have more of an impact on complication rate than drainage modality. All suction modalities of drainage seem to be safe. Operator technique, attention to symptom development, amount of fluid removed, and intrapleural pressure changes may be important in predicting complication development, and therefore, may be useful in choosing which technique to employ. Specific drainage modes and their complications need to be further studied.