Ong K C, Indumathi V, Raghuram J, Ong Y Y
Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.
Respirology. 2000 Jun;5(2):99-103. doi: 10.1046/j.1440-1843.2000.00235.x.
Differing success rates of various pleurodesis agents have been reported in the management of malignant pleural effusions. A randomized clinical trial was conducted to compare the efficacy of two commonly used agents, talc and bleomycin, for the pleurodesis of malignant pleural effusions.
Inclusion in the study required proof of a malignant pleural effusion by fluid cytology or pleural biopsy. Exclusion criteria included trapped lung, loculated effusions, recurrent effusions and life expectancy < 1 month. Five grams of talc or 1 unit per kilogram bodyweight of bleomycin mixed in 150 mL of normal saline was administered via tube thoracostomy after complete drainage of the pleural effusion in each patient. Treatment success was defined as the absence of recurrent pleural effusion on the chest radiograph 1 month after pleurodesis.
Treatment success was achieved in 16 out of 18 patients (89%) in the talc slurry group versus 14 out of 20 patients (70%) in the bleomycin group (P=0.168). Fever and pain were the only side-effects of pleurodesis in both groups.
These results indicate that talc slurry is as effective as bleomycin in preventing early recurrence of malignant pleural effusions. Pleurodesis with talc instead of bleomycin can result in significant cost savings.
在恶性胸腔积液的治疗中，已报道了各种胸膜固定术药物的不同成功率。进行了一项随机临床试验，以比较两种常用药物滑石粉和博来霉素在恶性胸腔积液胸膜固定术中的疗效。
纳入本研究需要通过胸水细胞学检查或胸膜活检证实为恶性胸腔积液。排除标准包括肺陷闭、局限性胸腔积液、复发性胸腔积液和预期寿命<1个月。在每位患者胸腔积液完全引流后，通过胸腔闭式引流管给予5克滑石粉或每公斤体重1单位博来霉素溶于150毫升生理盐水中。治疗成功定义为胸膜固定术后1个月胸部X线片上无复发性胸腔积液。
滑石粉悬液组18例患者中有16例（89%）治疗成功，而博来霉素组20例患者中有14例（70%）治疗成功（P=0.168）。发热和疼痛是两组胸膜固定术仅有的副作用。
这些结果表明，滑石粉悬液在预防恶性胸腔积液早期复发方面与博来霉素一样有效。用滑石粉而非博来霉素进行胸膜固定术可显著节省费用。
