协和医学杂志

2018, v.9(06) 566-568

[打印本页] [关闭]
本期目录(Current Issue) | 过刊浏览(Past Issue) | 高级检索(Advanced Search)

理性与无奈的选择:美国2018版恶性胸腔积液管理指南中的7个问题
Rational and Helpless Choices: Seven Issues of 2018 ATS/STS/STR Management Guideline for the Malignant Pleural Effusion

施焕中;
SHI Huan-zhong;Department of Respiratory and Critical Care Medicine & Beijing Institute of Respiratory Medicine,Beijing Chao-yang Hospital Affiliated to Capital Medical University;

摘要(Abstract):

由美国胸科学会、胸外科医师学会以及胸科放射学会制定的《恶性胸腔积液管理指南》于2018年10月1日在《美国呼吸和危重症监护医学杂志》发表。多学科专家组采用GRADE方法 (建议、评估、发展和评价分级),以PICO [Population (患者),Intervention (干预),Comparator (比较)和Outcomes (结果)]形式,提出并回答了恶性胸腔积液(malignant pleural effusion,MPE)临床管理中存在的7个问题并呈现其相关证据,形成推荐建议以指导实践。新指南推荐意见如下:(1)在超声引导下进行所需的胸腔穿刺或胸膜活检等操作;(2)无症状的已知病因或高度怀疑的MPE,无须胸腔穿刺排液;(3)为确定大量排液后能否缓解呼吸困难以及是否存在肺膨胀不全,对出现症状的MPE,尝试一次胸腔穿刺大量排液;(4)有症状的已知病因或高度怀疑的MPE,无肺膨胀不全,未曾接受过MPE治疗者,应选用埋管引流或胸膜固定术作为一线胸腔干预措施;(5)有症状的MPE患者接受滑石粉胸膜固定术时,喷洒滑石粉微粒和注入滑石粉匀浆疗效等同,可任选其中之一;(6)有症状的MPE患者存在肺膨胀不全、胸膜固定术失败或积液出现分隔,建议行埋管引流,胸膜固定术不再有治疗价值;(7)出现埋管引流相关感染时,无须拔除导管,使用抗生素治疗即可。
"Management of malignant pleural effusions( MPE) ",an official clinical practice guideline approved by the American Thoracic Society,the Society of Thoracic Surgeons,and the Society of Thoracic Radiology,was published in the American Journal of Respiratory and Critical Care Medicine on October1 st,2018. Using the GRADE( Grading of Recommendations,Assessment,Development,and Evaluation)approach and the PICO( Population,Intervention,Comparator,and Outcomes) format,a multidisciplinary panel raised and answered seven questions on the clinical management of MPE. The relevant evidences were summarized and recommendations were developed for clinical practice. Based on the available evidence,the panel made the following recommendations:( 1) ultrasound imaging should be used to guide pleural interventions in patients with known or suspected MPE;( 2) therapeutic pleural interventions should not be per-formed in asymptomatic patients with known or suspected MPE;( 3) either an indwelling pleural catheter( IPC) or chemical pleurodesis can be used in symptomatic patients with MPE and suspected expandable lung;( 4) large-volume thoracentesis can be conducted to assess symptomatic response and lung expansion;( 5) the use of either talc poudrage or talc slurry can be considered in patients with symptomatic MPE and expandable lung;( 6) IPC should be used instead of pleurodesis in patients with nonexpandable lung or failed pleurodesis; and( 7) antibiotics should be used in IPC-associated infections and there is no need to removed the catheter.

关键词(KeyWords): 恶性胸腔积液;指南;解读
malignant pleural effusions;guideline;interpretation

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 施焕中;
SHI Huan-zhong;Department of Respiratory and Critical Care Medicine & Beijing Institute of Respiratory Medicine,Beijing Chao-yang Hospital Affiliated to Capital Medical University;

Email:

DOI:

扩展功能
本文信息
服务与反馈
本文关键词相关文章
本文作者相关文章
中国知网
分享