How to drain pleural effusion?

Patients need to pay attention to the correct choice of treatment for pleural effusion. Among the common treatment methods, pleural effusion drainage therapy is included. However, the amount of thoracentesis and drainage should not exceed 1000 ml each time, and it should not be too fast or too much, so as not to cause a sudden drop in chest pressure and pulmonary edema.

(1) Anti-tuberculosis drug treatment (see the chapter on pulmonary tuberculosis).

(2) Thoracentesis: Moderate or more effusion requires therapeutic thoracentesis to relieve or eliminate the symptoms of pulmonary and cardiovascular compression, reduce fibrin deposition and pleural thickening, and reduce or avoid the possibility of affecting lung function. In addition, fluid extraction therapy can alleviate the toxic symptoms of tuberculosis. The amount of fluid drawn each time should not exceed 1000 ml, and it should not be too fast or too much, so as to avoid a sudden drop in chest pressure and the occurrence of pulmonary edema after re-expansion. If dizziness, pale face, sweating, palpitations, and cold limbs occur during the extraction process, it is considered a "pleural reaction" and the operation should be stopped immediately, and the patient should be laid flat. Changes in blood pressure and other symptoms should be closely observed. If necessary, 0.375g of nikethamide (coramine) should be injected intramuscularly or 0.5ml of 0.1% epinephrine should be injected subcutaneously.

(3) Glucocorticoids: Glucocorticoids can reduce inflammatory responses, alleviate the poisoning symptoms of tuberculous pleural effusion, accelerate the absorption of pleural effusion (shorten the absorption time of effusion), and reduce the chance of pleural thickening and adhesion. However, glucocorticoids have immunosuppressive functions and can cause dissemination of tuberculosis, so they must be used with caution. Under the premise of effective anti-tuberculosis treatment, it is mainly used for patients with moderate or above pleural effusion who have severe tuberculosis toxic symptoms and have not been effectively relieved by fluid extraction and anti-tuberculosis treatment. Small to medium doses (15-30 mg/d of prednisone) are used, and the course of treatment generally does not exceed 4-6 weeks. It is required to reduce the dose or stop the medication as soon as possible after the symptoms are controlled.