Katja Adamič (Author), Vladimir Dimitrić (Author), Vesna Nikolić (Author), Aleš Rozman (Author), Mateja Marc-Malovrh (Author), Anita Meglič (Author)

Abstract

Izhodišča: Bolniki s plevralnim izlivom pogosto potrebujejo razbremenilno plevralno punkcijo (RPP), po kateri navajajo bolj ali manj izrazito olajšanje dispneje. Zaradi varnosti se priporoča, da se med RPP odstrani do 1.500 mL tekočine. Metode: V raziskavo smo vključili 96 bolnikov, pri katerih je bila potrebna RPP. Zbirali smo ocene stopnje dispneje na lestvici VAS pred, takoj po in 2 uri po RPP, pri 73 bolnikih pa še 24 ur po RPP ter beležili količino odstranjene tekočine. Med RPP smo z vodnim manometrom merili plevralne tlake, iz katerih smo izračunali elastanco plevralnega prostora in na podlagi meritev bolnike razdelili v skupine z različnimi elastančnimi krivuljami. Rezultati: Med začetnim plevralnim tlakom in količino odstranjene tekočine ter olajšanjem dispneje po opravljeni RPP smo ugotovili statistično značilno povezanost. Pri največjem deležu bolnikov smo RPP zaključili zaradi pojava simptomov, zaradi meritev plevralnega tlaka pa smo RPP prekinili pri 16 bolnikih (16,7 %). V skupino z normalno elastančno krivuljo smo uvrstili 74 bolnikov, nezmožnost razpenjanja pljuč pa smo ugotovili pri 22 bolnikih. Med RPP ni bilo pomembnih zapletov, kljub temu da smo več kot 1.500 mL izliva odstranili pri 32 (33 %) bolnikih. Zaključek: Višji začetni plevralni tlak je šibko povezan z višjo začetno stopnjo dispneje in večjim olajšanjem dispneje po opravljeni RPP. Najbolj uporabna je dinamika sprememb plevralnega tlaka, s katero lahko že med RPP prepoznamo nezmožnost razpenjanja pljuč. Med RPP s plevralno manometrijo lahko varno odstranimo tudi več kot 1.500 mL tekočine

Keywords

elastančne krivulje;nezmožnost razpenjanja pljuč;

Data

Language: Slovenian
Year of publishing:
Typology: 1.01 - Original Scientific Article
Publisher: Slovensko zdravniško društvo
UDC: 616.2
COBISS: 113697539 Link will open in a new window
ISSN: 1581-0224
Views: 3
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Other data

Secondary language: English
Secondary title: Measurement of pleural pressure during therapeutic thoracentesis (pleural manometry) as a safe and objective method in the assessment of pleural effusion effect on symptom expression
Secondary abstract: Background: Patients with pleural effusion often require therapeutic thoracentesis (TT), which results in more or less pronounced dyspnea relief. Due to safety concerns, it is recommended to remove up to a maximum of 1500 mL effusion in one session. Methods: 96 patients in whom TT was indicated were included in the study. VAS dyspnea score before, immediately after, two hours after TT, and in 73 patients additionally 24 hours after TT was collected. The amount of fluid removed was measured. During TT, water manometer was used to measure pleural pressures, from which pleural space elastance was calculated. Based on their elastance curves characteristics, the patients were divided into different groups. Results: We found a correlation between initial pleural pressure/volume of effusion removed and dyspnea relief after TT. TT was most often terminated due to the onset of symptoms, in 16 patients it was terminated due to pleural pressure measurement. 74 patients were classified in the group with a normal elastane curve, in 22 patients we detected unexpandable lungs. Although more than 1500 mL of effusion was removed in 32 (33%) patients, there were no important complications during TT. Conclusion: Higher initial pleural pressure is weakly correlated with higher initial dyspnea and greater dyspnea relief after TT. The dynamic of pleural pressure change is useful for detecting unexpandable lungs during TT. During TT with pleural manometry, more than 1500 mL of pleural fluid can be safely removed.
Secondary keywords: elastance curves;unexpandable lung;Lung;Dyspnea;Visual analogue scale;Pljuča;Dispneja;Vizualna analogna lestvica;
Source comment: Nasl. z nasl. zaslona; Soavtorji: Katja Adamič, Vladimir Dimitrić, Vesna Nikolić, Aleš Rozman, Mateja Marc Malovrh; Besedilo v slov.; Opis vira z dne 4. 7. 2022;
Pages: str. 91-99
Volume: ǂVol. ǂ91
Issue: ǂšt. ǂ3/4
Chronology: Mar./Apr. 2022
DOI: 10.6016/ZdravVestn.3205
ID: 16306644