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，关于胸腔积液相关的病理生理变化，其引流和影响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)引流术后呼吸困难缓解的患者比例及特点。方法前瞻性纳入有症状的胸腔积液患者，在治疗前引流和治疗后24-36小时引流进行评估。结果145名受试者完成了排水前和排水后的测试;93%的患者胸腔积液≥25%。中位引流容积为1.68 L。引流后呼吸困难评分改善(平均视觉模拟评分(VAS)评分28.0±24 mm;呼吸困难-12 (D12)评分10.5±8.8; 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 -