| 摘要: |
| 目的 探讨胸腔内超声造影在胸腔积液治疗中的应用价值。方法 选取44例在我院行胸腔闭式引流术后停流、且结合病情判断积液尚未完全引出的患者，观察生理盐水冲洗时引流管内阻力、是否可以抽出积液及抽出积液性状，以及超声造影下引流管、胸壁软组织、胸腔的增强情况，分别经临床和超声检查判断引流管内口是否脱出积液腔，并比较两者的准确性。结果 引流管内口位于积液腔内时，超声造影表现为引流管呈线形增强，而后积液腔缓慢增强；引流管脱出时，引流管呈短直线样增强、胸壁软组织内局限增强、积液腔内无增强。临床判断8例引流管内口仍位于积液腔内、36例脱出，超声判断29例引流管内口仍位于积液腔内、14例脱出、1例无法判断。以生理盐水冲洗或药物注射后24 h内是否还有液体引出作为引流管是否脱出的标准，超声造影判断引流管是否脱出的准确率高于临床判断[97.73%（43/44）vs 50.00%（22/44），P<0.01]。结论 胸腔内的超声造影可以准确判断引流管位置及积液腔内部情况，可为胸腔积液的进一步治疗提供依据。 |
| 关键词: 超声造影检查 胸腔积液 胸腔闭式引流 留置导管 |
| DOI：10.16781/j.0258-879x.2018.10.1087 |
| 投稿时间：2018-07-06修订日期：2018-09-14 |
| 基金项目:上海市科学技术委员会2018年度医学引导类（中、西医）科技支撑项目（18411966700）. |
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| Value of intrathoracic contrast-enhanced ultrasound in closed thoracic drainage of pleural effusion |
| BI Ke1△,SHEN Meng-jun2△,ZHANG Yi2,TANG Chun-hong2,WANG Yin2* |
(1. Tongji University School of Medicine, Shanghai 200092, China;
2. Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To investigate the value of intrathoracic contrast-enhanced ultrasound in the treatment of pleural effusion. Methods Forty-four patients in our hospital were selected; they had stopped drainage during closed thoracic drainage and had residual pleural effusion determined by pathogenetic condition. The resistance in the catheter during normal saline flushing, whether the effusion could be drained and the effusion traits, and the enhancement of catheter, chest wall soft tissue and pleural cavity after contrast-enhanced ultrasound were all observed. Clinical and ultrasound examination was used to judge whether the catheters were out of the effusion cavity and the accuracies of the two examination methods were compared. Results When the catheter was located in the effusion cavity, contrast-enhanced ultrasound showed a linear enhancement in the catheter and a slow enhancement in the effusion cavity; when the catheter was removed, contrast-enhanced ultrasound showed a short linear enhancement in the catheter, a limited area of enhancement in the chest wall soft tissue and no enhancement in the effusion cavity. In clinical judgment, 8 catheters were located in the effusion cavity, and 36 cases were removed. In ultrasound judgment, 29 catheters were located in the effusion cavity, 14 cases were removed, and 1 case could not be judged. Taking whether there is still liquid extraction 24 h after saline flushing or drug injection as the standard of catheter removing, we found that the accuracy of contrast-enhanced ultrasound in determining catheter removing was significantly higher than that of the clinical judgment (97.73%[43/44] vs 50.00%[22/44], P<0.01). Conclusion Intrathoracic contrast-enhanced ultrasound can accurately judge the position of catheters and the internal condition of the effusion cavity. It provides a basis for further treatment of pleural effusion. |
| Key words: contrast-enhanced ultrasound pleural effusion closed thoracic drainage indwelling catheters |
