Chest：肺活检增加支气管针吸活检术并发症

    美国德克萨斯大学MD安德森癌症中心的一项研究表明，经支气管肺活检（TBBX）是支气管内超声引导下的经支气管针吸活检术（EBUS-TBNA）（应用）期间引起并发症发生的唯一风险因素。快速现场细胞学评估（ROSE）显著降低TBBX的使用。该论文发表在2013年第4期《胸科杂志》[Chest. 2013; 143(4):1044-1053]。
　　研究者从美国胸内科医师学会质量改进登记、评估和教育（American College of Chest Physicians Quality Improvement Registry, Evaluation, and Education ，简称AQuIRE）数据库中提取前瞻性纳入接受EBUS-TBNA患者的资料，并分析其发生率、结果和并发症预测因子。
　　研究者纳入6家医院1317例患者。19例患者发生并发症（1.44%）。TBBX是并发症的唯一风险因素，接受肺活检的患者并发症发生率为3.21%，而未接受的患者发生率为1.15%（OR=2.85，P=0.04）。
　　7例患者发生气胸（0.53%）。14例患者护理水平升级（1.06%）；其风险因素是年龄＞70岁（OR=4.06，P=0.012）、住院病人状态（OR=4.93，P=0.019）、接受深度镇静或全身麻醉（OR=4.68，P=0.048）。采用ROSE时，仅12.6%的患者做了TBBX，而未采用ROSE时，19.1%的患者做了TBBX（P=0.006）。采用ROSE时，医院间在TBBX使用上差异显著（P＜0.001）。

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Complications, Consequences, and Practice Patterns of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: Results of the AQuIRE Registry.
ABSTRACT BACKGROUND
Few studies of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) have been large enough to identify risk factors for complications. The primary objective of this study was to quantify the incidence of and risk factors for complications in patients undergoing EBUS-TBNA.
METHODS
Data from prospectively enrolled patients undergoing EBUS-TBNA in the American College of Chest Physicians Quality Improvement Registry, Evaluation, and Education (AQuIRE) database were extracted and analyzed for the incidence, consequences and predictors of complications.
RESULTS
We enrolled 1,317 patients at six hospitals. Complications occurred in 19 patients (1.44%; 95% CI, 0.87%-2.24%). TBBx was the only risk factor for complications, which occurred in 3.21% of patients who underwent the procedure and in 1.15% of those who did not (OR, 2.85; 95% CI, 1.07-7.59; P = 0.04). Pneumothorax occurred in seven patients (0.53%; 95% CI, 0.21%-1.09%). Escalations in level of care occurred in 14 patients (1.06%; 95% CI, 0.58%-1.78%); its risk factors included age > 70 years (OR, 4.06; 95% CI, 1.36-12.12; P = 0.012), inpatient status (OR, 4.93; 95% CI, 1.30-18.74; P = 0.019), and undergoing deep sedation or general anesthesia (OR, 4.68; 95% CI, 1.02-21.61; P = 0.048). TBBx was performed in only 12.6% of patients when rapid on-site cytologic evaluation (ROSE) was used and in 19.1% when it was not used (P = 0.006). Interhospital variation in TBBx utilization when ROSE was used was significant (P < 0.001).
CONCLUSIONS
TBBx was the only risk factor for complications during EBUS-TBNA procedures. ROSE significantly reduced the use of TBBx.