TY - T1的胸腔积液和症状的评估(请)研究患者的呼吸困难的症状性胸腔积液JF -欧洲呼吸杂志》乔和J - 10.1183/13993003.00980 -2019欧元六世- 55 - 5 SP - 1900980 AU Muruganandan Sanjeevan AU -泽帕迪,Maree AU -托马斯,Rajesh AU -菲茨杰拉德,Deirdre B. AU - Kuok, Yi Jin AU - Cheah, Hui Min AU - Read, Catherine A. AU - Budgeon, Charley A. AU - Eastwood, Peter R. AU - Jenkins, Susan AU - Singh, Bhajan AU - Murray, Kevin AU - Lee，Y.C. Gary Y1 - 2020/05/01 UR - //www.qdcxjkg.com/content/55/5/1900980.abstract N2 -介绍胸腔积液相关的病理生理变化、其引流和控制症状反应的因素尚不清楚。我们的目的是确定:1)胸腔积液(及其引流)对心肺、功能和膈肌参数的影响;2)引流术后出现喘憋缓解的患者比例及特点。方法对前瞻性入组的有症状性胸腔积液患者进行治疗前引流和治疗后24-36小时引流的评估。145名参与者完成了引流前和引流后的测试;93%的半胸积液≥25%。中位引流量为1.68 L。术后呼吸困难评分改善(平均视觉模拟评分(VAS)提高28.0±24mm;呼吸困难-12 (D12)评分10.5±8.8分; resting Borg score before 6-min walk test (6-MWT) by 0.6±1.7; all p<0.0001). The 6-min walk distance (6-MWD) increased by 29.7±73.5 m, p<0.0001. Improvements in vital signs and spirometry were modest (forced expiratory volume in 1 s (FEV1) by 0.22 L, 95% CI 0.18–0.27; forced vital capacity (FVC) by 0.30 L, 95% CI 0.24–0.37). The ipsilateral hemi-diaphragm was flattened/everted in 50% of participants pre-drainage and 48% of participants exhibited paradoxical or no diaphragmatic movement. Post-drainage, hemi-diaphragm shape and movement were normal in 94% and 73% of participants, respectively. Drainage provided meaningful breathlessness relief (VAS score improved ≥14 mm) in 73% of participants irrespective of whether the lung expanded (mean difference 0.14, 95% CI 10.02–0.29; p=0.13). Multivariate analyses found that breathlessness relief was associated with significant breathlessness pre-drainage (odds ratio (OR) 5.83 per standard deviation (sd) decrease), baseline abnormal/paralyzed/paradoxical diaphragm movement (OR 4.37), benign aetiology (OR 3.39), higher pleural pH (OR per sd increase 1.92) and higher serum albumin level (OR per sd increase 1.73).Conclusions Breathlessness and exercise tolerance improved in most patients with only a small mean improvement in spirometry and no change in oxygenation. Breathlessness improvement was similar in participants with and without trapped lung. Abnormal hemi-diaphragm shape and movement were independently associated with relief of breathlessness post-drainage.The majority of patients improve after pleural fluid drainage. Abnormal diaphragmatic function may be an important contributor to breathlessness in patients with pleural effusion. http://bit.ly/2SyF8RW ER -