目的:比较两种胸腔积液引流方法的效果。方法:统计210例(A组)使用中心静脉导管引流胸腔积液患者的引流胸水量、胸水消失天数、胸水完全吸收率,并与182例(B组)使用传统抽液引流胸腔积液患者进行对比研究。结果:平均胸水量A组(4682±1235)mL,B组(2470±1040)mL;胸水消失天数:A组(6.5±2.6)d,B组(23.6±9.3)d;胸水完全吸收率:A组73.8%,B组25.8%,两组各指标均具有显著性差异(Plt;0.01)。结论:中心静脉导管引流胸腔积液较传统穿刺方法安全有效。
ObjectiveTo systematically review the diagnostic value of neuron specific enolase (NSE) for malignant pleural effusion. MethodsWe comprehensively searched databases including The Cochrane Library (Issue 1, 2012), EMbase, MEDLINE, CBM, CNKI, WanFang Data and VIP from inception to January 2012 to collect studies about the diagnostic value of NSE for malignant pleural effusion. Literature screening according to the inclusion and exclusion criteria, data extraction and methodological quality assessment were completed by two reviewers independently. Then Meta-DiSc software (version 1.4) was used for pooling analysis. ResultsA total of 12 studies were finally included. The results of meta-analysis showed that the value of pooled specificity, sensitivity, positive likelihood radio, negative likelihood radio and diagnostic odds ratio (DOR) were 0.79 (0.76 to 0.84), 0.55 (0.51 to 0.59), 3.2 (1.94 to 5.29), 0.58 (0.45 to 0.74), 7.56 (3.74 to 15.30), respectively; and the area under SROC curve (AUC) was 0.813 1. ConclusionUsing NSE as a maker to diagnose malignant pleural effusion is of certain clinical value, which is used to differentiate benign and malignant pleural effusion.
Objective To overview the systematic reviews of recombinant human endostatin combined with platinum compounds for malignant pleural effusion (MPE). Methods According to the inclusion and exclusion criteria and searching strategies, we screened the systematic reviews of recombinant human endostatin combined with platinum compounds for the treatment of MPE by searching the Embase, PubMed, Clinical Trials, Cochrane Library, China National Knowledge Infrastructure, CQVIP Database and Wanfang Database. The searching time was from January 1999 to December 2021. The methodological quality was evaluated using AMSTAR 2 tool, the report quality was evaluated using PRISMA statement, and the evidence quality of the outcome indicators was graded according to the GRADE system. Finally, RevMan 5.3 software was used to quantitatively merge and analyze the original research effect values of the main outcome indicators with low level of evidence. Results A total of 9 systematic reviews/meta-analyses involving 8 outcome indicators and totally 50 outcomes were included. The average PRISMA scale score was 22.28±1.37, with 6 reports being relatively complete and 3 reports having certain reporting defects. The overall methodological quality of the 9 systematic reviews was extremely low. Most of the 50 outcomes were graded as “low” (31 outcomes) or “intermediate” (18 outcomes) quality. The results of 9 systematic reviews all showed that the clinical efficacy of dual therapy was more satisfactory than that of platinum-based preparations in the treatment of MPE, and re-quantitative analysis also confirmed that there was no statistically significant difference in the incidence of adverse events between the two treatments (P>0.05). Conclusions Considering the existing evidence and the results of meta-analysis, the dual therapy composed of recombinant human endostatin and platinum compounds is more effective in the treatment of MPE, and there is no difference in the incidence of related adverse events. However, because of its poor methodological quality and the low level of evidence, the above conclusions can only provide a certain reference and need to be confirmed by further research.
Objective By comparing the clinical characteristics, etiological characteristics, laboratory examination and prognosis of community acquired pneumonia (CAP) patients with and without pleural effusion (PE), the risk factors affecting the 30-day mortality of CAP patients with PE were analyzed. Methods The clinical data of inpatients with CAP in 13 hospitals in different regions of China from January 1, 2014 to December 31, 2014 were analyzed retrospectively. According to the imaging examination, the patients were divided into two groups: PE group (with pleural effusion) and non-PE group (without pleural effusion). The clinical data, treatment, prognosis and outcome of the two groups were compared. Finally, multivariate analysis was used to analyze the risk factors of 30-day mortality in patients with PE. Results Of the 4781 patients with CAP, 1169 (24.5%) were PE patients, with a median age of 70 years, and more males than females, having smoking, alcoholism, inhalation factors, long-term bed rest, complicated with underlying diseases and complications, such as respiratory failure, acute respiratory distress syndrome (ARDS), cardiac insufficiency, septic shock, acute renal failure and so on. The hospitalization time was prolonged; the intensive care unit (ICU) occupancy rate, mechanical ventilation rate, mortality within 14 days and mortality within 30 days in the PE group were higher than those in the non-PE group. Multivariate analysis showed that the risk factors affecting 30-day mortality in the patients with PE were urea nitrogen >7 mmol/L (OR=2.908, 95%CI 1.095 - 7.724), long-term bed rest (OR=4.308, 95%CI 1.128 - 16.460), hematocrit <30% (OR=4.704, 95%CI 1.372 - 16.135), acute renal failure (OR=5.043, 95%CI 1.167 - 21.787) and respiratory failure (OR=6.575, 95%CI 2.632 - 16.427), ARDS (OR=8.003, 95%CI 1.852 - 34.580). ConclusionsThe hospitalization time and ICU stay of PE patients are prolonged, the risk of complications increases, and the hospital mortality increases significantly with the increase of age, complication and disease severity. The independent risk factors affecting 30-day mortality in PE patients are urea nitrogen >7 mmol/L, long-term bed rest, hematocrit <30%, acute renal failure, respiratory failure, and ARDS.
Objective To evaluate the efficacy of intrapleural urokinase treatment for unloculated tuberculous pleural effusion. Methods Chinese Conference Data, Chinese Biomedical Database, VIP Database,Wanfang Database, Cochrane Library, PubMed, and Evidence-based Medical Evaluation Database were searched up to February 2012, and the studies as references of eligible articles were also searched. Randomized controlled trials were included for evaluating the efficacy of intrapleural urokinase treatment for unloculated tuberculous pleural effusion. Mean difference MD and 95% confidence interval ( 95% CI) were calculated for the efficacy of urokinase in the treatment. After the test for heterogeneity, forest map was used to analyze the efficacy of intrapleural urokinase treatment. The funnel plot was used to discuss the publication bias. Results Nine randomized controlled trials met all eligible criteria. This meta-analysis indicated that compared with the conventional treatment, the urokinase treatment increased total drainage( pumping liquid) ( P lt; 0. 000 01) , decreasd residual pleural thickening ( P lt; 0. 000 01) , improved lung function with significant increase in FEV1% pred ( P lt; 0. 000 01) . Conclusions Compared with the conventional treatment( anti-tubercular treatment in combination with pumping pleural effusion) , the treatment which injects urokinase to chest cavity can increase total pleural effusion, decrease residual pleural thickening, and improve the lung function.
目的:为了提高漏出性胸腔积液的诊断率对其进行病因分析。方法:对54 例漏出性胸腔积液病例就不同年龄及病变部位进行分析。结果:50 岁以下以肾病综合征居首位;50~ 60岁以岁慢性肺源性心脏病右心衰竭及肝硬化为主;60 岁以上岁以慢性肺源性心脏病右心衰竭居发病之首,其次为冠状动脉粥样硬化性心脏病。左侧以心包积液为主。右侧以慢性肺源性心脏病右心衰竭居发病之首,其次为冠状动脉粥样硬化性心脏病,肝硬化居第三。双侧以慢性肺源性心脏病右心衰竭居首位,其次为肾病综合征,高血压心脏病居第三。结论:漏出性胸腔积液的发病年龄,病变部位不同病因各异。