Light R W, Nguyen T, Mulligan M E, Sasse S A
Pulmonary Disease Program, Saint Thomas Hospital, Nashville, TN 37202, USA.
Lung. 2000;178(1):13-8. doi: 10.1007/s004080000002.
Patients with loculated parapneumonic effusion or empyema are sometimes treated with streptokinase or urokinase in an attempt to facilitate pleural fluid drainage by liquefying the pleural exudate and destroying the fibrin membranes producing the loculation. This study evaluated the effectiveness of streptokinase, urokinase, and Varidase (the combination of streptokinase and streptodornase) in liquefying gummy, purulent, exudative material from loculated empyemas. An empyema was created by injecting 10(8) Pasteurella multocida bacteria into the pleural space of New Zealand white rabbits. Twenty specimens, each containing 0.5 g of purulent material obtained 5 days after empyema induction, were placed in test tubes. Streptokinase (15,000 IU), urokinase (10,000 IU), Varidase (4,000-15,000 IU streptodornase + 15,000 IU streptokinase) or saline was added to five sets of four test tubes each. The amount of nonliquefied material that remained after incubation with the fibrinolytic agents was quantitated. Over the 6-h incubation period, the amount of nonliquefied material decreased from 0.5 g to 0.02 g in the Varidase group but never decreased to less than 0.4 g in any of the other three treatment groups. Liquefaction of thick pleural exudates from rabbits with empyema can be achieved with Varidase but not with streptokinase or urokinase.
局限性类肺炎性胸腔积液或脓胸患者有时会接受链激酶或尿激酶治疗，试图通过液化胸腔渗出液和破坏导致局限性的纤维蛋白膜来促进胸腔积液引流。本研究评估了链激酶、尿激酶和Varidase（链激酶与链道酶的组合）对液化局限性脓胸的粘性、脓性渗出物的有效性。通过向新西兰白兔的胸腔内注射10(8)多杀巴斯德菌来制造脓胸。在诱导脓胸5天后，从每只兔子获取20个标本，每个标本含有0.5g脓性物质，并将其置于试管中。分别向五组试管（每组四个）中加入链激酶（15,000 IU）、尿激酶（10,000 IU）、Varidase（4,000 - 15,000 IU链道酶 + 15,000 IU链激酶）或生理盐水。对与纤溶药物孵育后剩余的未液化物质进行定量。在6小时的孵育期内，Varidase组中未液化物质的量从0.5g降至0.02g，但在其他三个治疗组中，未液化物质的量从未降至低于0.4g。Varidase可使兔脓胸的浓稠胸腔渗出液液化，但链激酶或尿激酶则不能。
