Pdf-Torakosentesis Compress
Pdf-Torakosentesis Compress
Pdf-Torakosentesis Compress
@bea :
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yla 9=;
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]resept`r :
kr. Orvlg Hekos`g, ^p.](C) DO^Y, DL]^Y
kr. Degty Lgffrlogy, ^p.], DL]^Y
ILFOLG ]UBH@G@B@FO
DLCUB[L^ CEK@C[EYLG UGOTEY^O[L^ LGKLBL^
Y^U] KY. H KJLHOB ]LKLGF
9=9=
[`rlsegtesos: ^tlte-`d-Lrt klblh Celhlglg ]r`sekurlb, Alsob ]lsoeg klg
Klhplc Doso`b`fos
Listrlc
Eduso pbeurl serogf terjlko klg hegyeiliclg h`riokotls klg h`rtlbotls
ylgf togffo plkl ierilflo plsoeg. [`rlsegtesos klplt hegfurlgfo fejlbl ylgf
sofgod
sofgodocl
oclg
g klg lklgy
lklgyll perilo
periloclg
clg plkl
plkl plrlhe
plrlheter
ter doso`b`
doso`b`fos
fos terhlsu
terhlsuc
c kospge
kospgel,
l,
`blarlfl klg tokur. Cehljulg terilru, pegffugllg ubtrls`goc `bea toh pr`sekurlb
causus klplt hegogfcltclg celhlglg t`rlsegtesos. Alb ogo hehugfcogclg ugtuc
koblcuclg
koblcuclg t`rlsegtesos
t`rlsegtesos plkl ogkovoku
ogkovoku kegflg
kegflg resoc` togffo seperto plkl plsoeg
kegflg
kegflg rosoc`
rosoc` perklr
perklrlal
lalg
g ylgf
ylgf togffo
togffo,, eduso
eduso pbeurl
pbeurl ioblter
ioblterlb.
lb. Ublslg
Ublslg ogo lclg
lclg
herl
herlgf
gfcu
cuh
h cehl
cehlju
julg
lg teri
terilr
lru
u klbl
klblh
h ce
celh
lhlg
lglg
lg pr
pr`s
`sek
ekur
ur t`
t`rl
rlse
segt
gtes
esos
os,,
pegfurlgflg fejlbl setebla t`rlsegtesos klg pehlalhlg tegtlgf klslr doso`b`fos
ugtuc periloclg plsoeg.
]egklaubulg
Eduso pbeurl kokolfg`sos plkl beioa klro <,5 jutl `rlgf ko Lherocl ^eroclt
setolp tlauggyl klg koseiliclg `bea ierilflo c`gkoso hekos ylgf hegklslro.
]egyeili plbogf uhuh klro eduso pbeurl lklbla flflb jlgtugf c`gfestod koocuto
`bea ogdecso pbeurl klg ceflglslg. Lklgyl eduso pbeurl koclotclg kegfg h`rtlbotls
ylgf
ylgf togffo
togffo,, lplpug
lplpug pegyei
pegyeilig
ligyl
yl klg h`riok
h`riokotl
otlss ylgf
ylgf sofgod
sofgodocl
oclg
g terhlsuc
terhlsuc
kosp
kospge
gell kl
klg
g pe
pegu
guru
rugl
glg
g cu
culb
lbot
otls
ls aoku
aokup.
p. Hecl
Heclgo
gosh
shee yl
ylgf
gf hegk
hegklsl
lslro
ro ug
ugtu
tuc
c
hegfurlgfo fejlbl setebla t`rlsegtesos lklbla hubtodlct`rolb, tetlpo cehugfcoglg
utlhlg
utlhlgyl
yl heboil
heboiltcl
tclg
g perilo
periloclg
clg klblh
klblh heclgo
heclgoshe
she `t`t
`t`t perglp
perglplslg
lslg kegflg
kegflg
kl
klhp
hplc
lc yl
ylgf
gf beio
beioa
a ce
ceno
nobb kl
klro
ro pe
pego
gogf
gfcl
cltl
tlg
g v`
v`bu
buhe
he pl
plru
ru kl
klg
g du
dugf
gfso
so pl
plru
ru..
[`rlseg
[`rlsegtes
tesos
os klplt
klplt koblcu
koblcuclg
clg ugtuc
ugtuc kolfg`
kolfg`sto
stoc
c klg terlpeu
terlpeutoc
toc kegflg
kegflg tujulg
tujulg
hegfurlgfo fejlbl klg hehuboaclg culbotls aokup ylgf koseiliclg `bea kospgel.
C`hpboclso
C`hpboclso ylgf plbogf
plbogf uhuh klro t`rlsegtesos
t`rlsegtesos lklbla pgeuh`t`rlcs.
pgeuh`t`rlcs.
Ierilf
Ierilflo
lo togfcl
togfcltt pgeuh`
pgeuh`t`r
t`rlcs
lcs tebla
tebla koblp`
koblp`rcl
rclg
g klblh
klblh boterl
boterltur
tur (=% ->?%).
->?%).
C`hpboclso blog terhlsuc gyero, seslc glpls, ltlu relcso vls`vlflb. C`hpboclso
ylgf jlrlgf tetlpo serous lklbla perklrlalg, ekehl plru reecsplgso, klg tusuclg
`rflg ylgf toklc kosegfljl. Klblh ieierlpl tlaug terlcaor, togfclt c`hpboclso
ylgf terclot kegflg t`rlsegtesos tebla hegurug kegflg pegffugllg plgkulg U^F
, pehoboalg
pehoboalg b`clso ylgf ieglr, pegfehilgflg
pegfehilgflg toh pr`sekurlb,
pr`sekurlb, klg cetlltlg
cetlltlg ylgf
cetlt teralklp
teralklp pr`t`c`b
pr`t`c`b ugoverslb.
ugoverslb. ]egflhltlg
]egflhltlg blgfcla-blg
blgfcla-blgfcla
fcla celhlglg
celhlglg ogo
hehugfcogclg koblcuclggyl t`rlsegtesos plkl plsoeg kegflg nlcuplg ylgf beioa
buls tlgpl c`hpboclso ylgf hegogfclt, terhlsuc plsoeg kegflg rosoc` perklrlalg
klg plsoeg
plsoeg kegflg
kegflg eduso
eduso pbeurl
pbeurl ioblte
ioblterlb.
rlb. Ierocu
Ierocutt ogo lclg
lclg kotogj
kotogjlu
lu cehlju
cehljulg
lg
terilru
terilru klblh
klblh celhlg
celhlglg
lg pr`sek
pr`sekur
ur t`rlseg
t`rlsegteso
tesos,
s, hegfao
hegfaoblg
blgfcl
fclg
g fejlbl
fejlbl setebla
setebla
t`rlsegtesos klg pehlalhlg tegtlgf klslr doso`b`fos ugtuc periloclg plsoeg.
Ltebectlsos, hl
hlss
ssll plru
plru,, c`gs
c`gs`b
`bok
okls
lsoo pl
plre
regc
gcoh
oh,, kl
klg
g pe
pego
gogf
gfcl
cltl
tlg
g
aehoko
aehokoldrl
ldrlfh
fhll klplt
klplt hehoboc
hehobocoo tehulg
tehulg pehero
peherocsl
csllg
lg rlko`f
rlko`frldo
rldo klg dosoc
dosoc ylgf
ylgf
serupl
serupl kegflg
kegflg eduso
eduso pbeurl
pbeurl.. Ubtrls`
Ubtrls`g`f
g`frldo
rldo teb
tebla
la teriuct
teriuctoo beioa
beioa edecto
edectodd klblh
klblh
hegfok
hegfokegto
egtodoc
doclso
lso eduso
eduso pbeurl
pbeurl klropl
klroplkl
kl rlko`f
rlko`frldo
rldo klkl
klkl klg pehero
peherocsl
csllg
lg dosoc
dosoc
glhug hlsoa alhpor slhl segsotodgyl kegflg n`hputek t`h`frlpay (N[). Jocl
koilgk
koilgkogf
ogfclg
clg kegflg
kegflg N[ t`rlcs
t`rlcs ugtuc
ugtuc ketecs
ketecsoo eduso
eduso pbeurl
pbeurl,, U^F hehoboc
hehobocoo
segsotodotls ?9% klg spesodotls ?>% . Alb ogo hegyeiliclg tersekolgyl slrlgl
p`rtlieb ugtuc hegfevlbulso plsoeg ko slhpogf tehplt tokur klg hegfaogklro
plplrlg rlkolso. Koln`g et lb hehilgkogfclg pegffugllg U^F kegflg
peherocsllg dosoc ugtuc hegegtuclg b`clso t`rlsegtesos ylgf teplt klg
hegehuclg
hegehuclg ilawl <5% b`clso ylgf kotlgklo algyl ierklslrclg
ierklslrclg peherocsllg
peherocsllg
dosoc ierlkl plkl p`soso ylgf ierp`tegso ilalyl. ^eblog otu herecl hegehuclg
ilawl pegffugllg U^F hegogfcltclg cehlhpulg ugtuc hegehuclg b`clso
pbeurl ylgf lhlg ugtuc lsporlso cetocl toklc nucup algyl kegflg peherocsllg
dosoc.
dosoc. [oklc
[oklc hegfae
hegfaerlg
rlgclg
clg ilawl
ilawl seiebu
seiebuh
h pegffu
pegffugll
gllg
g rutog
rutog U^F,
U^F, togfcl
togfcltt
c`hpbo
c`hpbocls
clsoo klro
klro t`rlseg
t`rlsegtes
tesos
os beioa
beioa togffo
togffo,, kegflg
kegflg kr
kryy tl
tlp
p, pgeuh`
pgeuh`t`r
t`rlcs
lcs klg
blserlso `rflg ylgf toklc kosegfljl beioa serogf kotehuclg.
]lgkul
]lgkulg
g seclrl
seclrlgf
gf hegkuc
hegkucugf
ugf pegffu
pegffugll
gllg
g rutog
rutog U^F relb-tohe ugtuc
okegtodoclso eduso pbeurl seblhl t`rlsegtesos. [ebla koiuctoclg senlrl c`gsosteg
ilawl pegffugllg U^F hegfurlgfo
hegfurlgfo togfclt c`hpboclso, ylotu pgeu
pgeuh`t`rlcs
h`t`rlcs klg
ceiutualg pehlslgflg naest tuie.
tuie. ^lbla sltu stuko pr`spectod cenob pertlhl ylgf
hehilgkogfclg pegffugllg U^F koilgkogfclg peherocsllg dosoc hegehuclg
ilawl U^F hegfurlgfo togfclt pgeuh`t`rlcs klro >=% hegjlko =%. ^ejlc otu,
ieierlpl pegebotolg blog tebla hegfc`gdorhlso tehulg ogo. Hetl-lglbysos ylgf
koblcuclg `bea F`rk`g et lb heherocsl togfclt pgeuh`t`rlcs setebla t`rlsegtesos
klg hegehuclg ilawl pegffugllg U^F lklbla prekoclt`r tercult tugfflb ugtuc
togfclt pgeuh`t`rlcs ylgf beioa regkla (`kks rlto` =,>3 ?5% n`gdokegne ogtervlb
=,9-=,6). ]egffugllg U^F jufl teriucto aehlt iolyl klg klplt hegfurlgfo iolyl
rlwlt oglp, hugfcog seilfolg clregl togfclt c`hpboclso ylgf beioa regkla.
[`rlsegtesos
[`rlsegtesos plkl ]lsoeg kegflg Yosoc` ]erklrlalg
]erklrlalg
]egklrlalg, terhlsuc aeh`ta`rlx, tebla kolhlto plkl <- >% plsoeg ylgf
hegjlbl
hegjlblgo
go t`rlseg
t`rlsegteso
tesos.
s. ^eiula
^eiula stuko teralkl
teralklp
p <?.>>?
<?.>>? togklclg
togklclg t`rlsegte
t`rlsegtesos
sos
hegu
hegugj
gjuc
uccl
clg
g il
ilaw
awll pe
pegf
gffu
fugl
gllg
lg U^F
U^F kl
klpl
pltt hegf
hegfur
urlg
lgfo
fo ce
cehu
hugf
gfco
cogl
glg
g
perklrlalg seieslr >?%. ]lsoeg ylgf korujuc ugtuc t`rlsegtesos serogfclbo
hehoboco c`gkoso c`h`riokotls ltlu hegf`gsuhso `ilt ylgf ierp`tegso hehiult
herecl ierosoc` beioa togffo
togffo hegflblho
hegflblho perklrlalg.
perklrlalg. ^eiula stuko t`rlsegtesos
t`rlsegtesos
ylgf koblcuclg plkl ><9 plsoeg kotehuclg ilawl ;9% hehoboco < ltlu beioa
dlct`r rosoc` perklrlalg. C`hote ]rlctoc ]eraohpuglg Ylko`b`fo Ogtervegso`glb
herec`hegklsoclg sultu stlgklr plkl tlaug 9=<9 ilawl ugtuc pr`sekur g`g
vlsc
vlscu
ublr
blr ylgf
lgf iere
iereso
soc
c` re
regk
gkla
la se
sepe
pert
rtoo t`
t`rl
rlse
seg
gte
teso
sos,
s, tl
tlrf
rfet
et ogterglto`glb
g`rhlbozek rlto` (OGY) alrus 29.= klg tr`hi`sot 7 5=.===/βB. [rlgsduso klrla
alrus kofugllclg ugtuc hegnlplo tlrfet ogo. ^eblog otu, kolgjurclg pegfegtolg
pegffuglllg nb`pok`freb seblhl 5 alro klg aeplrog ierlt h`becub regkla (b`w-
h`benublr-weofat aeplrog) seblhl < alro seiebuh pr`sekur. Glhug, rec`hegklso
ogo koklslrclg plkl kltl hogohlb klg ilru-ilru ogo kopertlgylclg.
]lk
]lkl tla
tlaug 9=
9=<=
<=,, Ir
Irot
otos
osa
a [a`
a`rl
rlno
nonn ^`no
^`noet
ety
y (I[
(I[^) heh
hehiero
ierocl
clg
g
rec`he
rec`hegkl
gklso
so beveb
beveb N ugtuc
ugtuc hegfao
hegfaogkl
gklro
ro t`rlseg
t`rlsegtes
tesos
os g`gurf
g`gurfegt
egt plkl
plkl plsoeg
plsoeg
kegflg OGY 7 <,5. ]ek`hlg I[^ terutlhl koklslrclg plkl < stuko `bea HnTly
klg [`y plkl tlaug <??<. ]egebotolg ogo hegugjucclg ilawl plkl 9<6 plsoeg
kegflg
kegflg c`lfu
c`lfub`p
b`plto
lto rogflg
rogflg ylgf
ylgf toklc
toklc ko`ilt
ko`iltoo (koked
(kokedogo
ogosoc
soclg
lg seilfl
seilfloo wlctu
wlctu
pr`tr`hiog (][) ltlu wlctu tr`hi`pblstog plrsolb (][[) aogffl kul clbo totoc
tegfla g`rhlb klg / ltlu juhbla tr`hi`sot 5=.===-??.=== /βB) toklc hehoboco
pegogfcltlg rosoc` perklrlalg setebla koblcuclg t`rlsegtesos. ^ejlc pek`hlg I[^
koteriotclg, lkl ieierlpl pegebotolg blog ylgf hegeboto rosoc` perklrlalg plkl
plsoeg ylgf hegjlblgo t`rlsegtesos. ]lkl tlieb < korlgfcuh stuko terilru tegtlgf
togk
togklc
lclg
lg t`
t`rl
rlseg
segte
tesos
sos pl
plkl
kl pl
plso
soeg
eg ke
kegf
gflg
lg roso
rosoc`
c` pe
perk
rklrl
lrlal
alg.
g. ^e
^eiu
iula
la stuk
stukoo
retr
retr`s
`spe
pect
ctod
od tera
teralk
lklp
lp <=64
<=64 plso
plsoeg
eg ylgf
ylgf ko
kobl
blcu
cucl
clg
g `b
`bea
ea ]l
]lte
tebb kl
klg
g J`
J`sa
saoo
hegugjucclg ilawl, hescopug plrlheter c`lfublso toklc koc`recso, toklc lkl
c`hpboclso aeh`rlfoc. Klblh pegebotolg ogo, seilfolg ieslr plsoeg kegflg OGY
lig`rhlb klg goblo tr`hi`sot regkla (<6% OGY7 9.=, 6% OGY7 9.5, ;% OGY7 >,
4% tr`h
tr`hi`
i`so
sott 25=.
25=.==
===
= /βB,
/βB, klg
klg <% tr`h
tr`hi`
i`so
sott 295.
295.==
===
= /β
/βB)
B).. ]e
]ege
gebo
boto
to
hegyoh
hegyohpub
pubclg
clg ilawl
ilawl pegobl
pegoblolg
olg c`lfub
c`lfublso
lso prl-pr
prl-pr`se
`sekur
kur toklc
toklc koperbu
koperbuclg
clg klg
lhilgf iltls alrus koaoblgfclg.
Aoii
Aoiier
ertt kl
klg
g re
recl
clgg
ggyl
yl hehi
hehilg
lgko
kogf
gfcl
clg
g 9 ce
ceb`
b`hp
hp`c
`c pl
plso
soeg
eg ke
kegf
gflg
lg
plrlheter c`lfublso prl pr`sekurlb lig`rhlb (kokedogosoclg seilflo OGY7 <,4 klg
tr`hi`sot
tr`hi`sot 25=.=== /βB). ^ltu ceb`hp`c
ceb`hp`c tebla hegerohl trlgsduso prl pr`sekurlb
pr`sekurlb
kl
klro
ro tr`h
tr`hi`
i`sot
sot ltlu
ltlu pblsh
pblshll ie
iecu
cu seflr,
seflr, se
sekl
klgf
gfcl
clg
g ce
ceb`
b`hp
hp`c
`c c`
c`gt
gtr`
r`bb tokl
toklc
c
hegerohl trlgsduso lpl pug. ^eilgylc 6=4 plsoeg toklc hegklpltclg trlgsduso,
klg toklc lkl c`hpboclso perklrlalg plkl ceb`hp`c ogo. ]lkl >=> plsoeg ylgf
hegklp
hegklplt
lt trlgsdu
trlgsduso
so seiebu
seiebuh
h t`rlseg
t`rlsegtes
tesos
os lkl ; c`hpbo
c`hpbocls
clsoo aeh`rl
aeh`rlfoc
foc plkl
plkl
ceb`hp`c
ceb`hp`c ogo. Herecl hegyohpubclg
hegyohpubclg ilawl perklrlalg
perklrlalg klro t`rlsegtesos
t`rlsegtesos jlrlgf
terjlko, t`rlsegtesos lhlg koblcuclg cetocl plrlheter c`lfublso toklc g`rhlb, klg
toklc lkl hlgdllt klro trlgsduso prl pr`sekurlb.
Klblh stuko ylgf koblcuclg `bea ]unalbsco klg reclggyl, ><9 plsoeg ylgf
hegjlblgo t`rlsegtesos kogoblo ugtuc rosoc` perklrlalg prl pr`sekurlb, terhlsuc
pegogfcltlg OGY, tr`hi`sot`pegol, flflb fogjlb, klg pegffugllg `ilt-`iltlg
ylgf terclot kegflg
kegflg rosoc` perklrlalg.
perklrlalg. Koilgkogf
Koilgkogfclg
clg kegflg
kegflg herecl
herecl ylgf toklc
hegogfcltclg rosoc` perklrlalg, toklc lkl periekllg c`hpboclso perklrlalg plkl
ceb`hp`c rosoc` ylgf beioa togffo (g8 <>=). ]lrl pegeboto hegyohpubclg ilawl
t`rlsegtesos
t`rlsegtesos klplt koblcuclg
koblcuclg kegflg
kegflg lhlg tlgpl c`recso
c`recso fllgffulg
fllgffulg c`lfublso
seiebuh koblcuclg togklclg.
Ilru-ilru
Ilru-ilru ogo, stuko n`a`rt pr`spectod
pr`spectod <9 tlaug, Lubt klg reclg-reclgg
reclg-reclggyl
yl
heblp`
heblp`rcl
rclg
g ilawl
ilawl plkl
plkl ?>9=
?>9= plsoeg
plsoeg ylgf
ylgf hegjlbl
hegjlblgo
go t`rlseg
t`rlsegteso
tesoss toklc
toklc lkl
auiugflg lgtlrl c`hpboclso perklrlalg kegflg goblo OGY, ][, klg tr`hi`sot.
Klblh
Klblh pegebo
pegebotolg
tolg ogo secotl
secotlrr 95% plsoeg
plsoeg kegflg
kegflg OGY 7<,5
7<,5 klg ;,5% kegflg
kegflg
tr`hi
tr`hi`s
`sot
ot 25=.
25=.==
===/
=/βB
βB.. Herec
Herecll hegy
hegyoh
ohpu
pubc
bclg
lg il
ilaw
awll kl
kltl
tl herec
herecll tokl
toklc
c
hegkucugf pek`hlg I[^ sllt ogo hegfeglo rosoc` perklrlalg plkl t`rlsegtesos.
^eblog
^eblog plrlhe
plrlheter
ter c`lfub
c`lfublso
lso ylgf
ylgf lig`rh
lig`rhlb,
lb, pegffu
pegffugll
gllg
g `ilt-`
`ilt-`ilt
iltlg,
lg,
caususgyl nb`pok`freb, tebla koclotclg kegflg rosoc` perklrlalg plkl plsoeg ylgf
hegjlblgo `perlso klg kolgfflp seilflo c`gtrlogkoclso teralklp pr`sekur iekla
ebectod. Glhug, pegfaegtolg nb`pok`freb senlrl kogo klplt hehoboco c`gsecuegso
ylgf dltlb seperto pegogfcltlg rosoc` tr`hi`sos stegt kegflg pegogfcltlg ogdlrc
ho`clrk klg cehltolg. Ieierlpl pegebotolg tebla hehilals celhlglg heblcuclg
t`rlseg
t`rlsegteso
tesoss plkl
plkl plsoeg
plsoeg ylgf
ylgf hehlcl
hehlcloo nb`pok
nb`pok`fr
`freb.
eb. [ofl
[ofl pubua
pubua plsoeg
plsoeg ylgf
ylgf
hehlclo nb`pok`freb tlgpl cebloglg c`lfublso bloggyl hegjlblgo t`rlsegtesosklro
pegebotolg `bea Zlbt klg reclggyl. Ceb`hp`c ogo toklc hegehuclg pr`sekur
plscl perklrlalg ylgf sofgodoclg. ^eblog otu, Hlah``k et lb hehpebljlro 95
plsoeg ylgf hehlclo nb`pok`freb ylgf hegjlblgo t`rlsegtesos ltlu pegehpltlg
naest tuie (<; Dregna). ^ltu plsoeg hehoboco aeh`t`rlcs ylgf sofgodoclg senlrl
cbogos plkl ceb`hp`c ogo. Klblh stuko terseiut ko ltls klro ><9 plsoeg ylgf
hegjlblgo t`rlsegtesos klro pegebotolg `bea ]unalbsco et lb, <5 plsoeg hegffuglclg
nb`pok`freb. [lc sltu pug klro plsoeg ogo hegflblho c`hpboclso perklrlalg plscl
pr`sekur. ^enlrl ierslhl-slhl, ieierlpl pegebotolg ogo hegugjucclg ilawl
cogerjl t`rlsegtesos hugfcog lhlg plkl plsoeg ylgf hehlclo nb`pok`freb.