Vargas F S, Teixeira L R, Antonangelo L, Vaz M A, Carmo A O, Marchi E, Light R W
Laboratory of Pleura, Division of Respiratory Diseases, Heart Institute, InCor, University of São Paulo Medical School, Brazil.
Chest. 2001 May;119(5):1516-20. doi: 10.1378/chest.119.5.1516.
To compare the pleurodesis results from the intrapleural injection of silver nitrate and talc slurry over an observation period of 12 months in rabbits.
Rabbits were randomized to receive 2 mL of 0.5% silver nitrate or 400 mg/kg of talc slurry in 2 mL intrapleurally. Ten rabbits in each group were killed at 1 month, 2 months, 4 months, 6 months, 8 months, 10 months, and 12 months after intrapleural injection. The degree of gross pleurodesis and the amount of microscopic pleural fibrosis and inflammation were graded on a scale of 0 to 4.
The mean +/- SEM gross pleurodesis score in the 70 rabbits that received silver nitrate was 3.34 +/- 0.08, which was significantly higher than the score of 2.32 +/- 0.09 in the 70 rabbits that received talc. The mean gross pleurodesis score was significantly higher at each of the observation times (p < 0.05), except at 2 months, in the rabbits that received silver nitrate. The pleurodesis was distributed throughout the thorax in the rabbits that received silver nitrate, while it was only in the ventral thorax in the rabbits that received talc slurry. The gross pleurodesis scores showed no tendency to decrease during the 12-month observation period in either treatment group. The persistence of talc in the pleural space did not lead to chronic inflammatory changes because the inflammation scores were similar in both groups at all observation times. The microscopic pleural fibrosis score tended to decrease with time in the silver nitrate group but not in the talc slurry group.
The intrapleural injection of 2 mL of 0.5% silver nitrate produces a better pleurodesis than does the intrapleural injection of 400 mg/kg of talc slurry in rabbits. The pleurodesis induced by silver nitrate persists for at least 1 year. The efficacy of silver nitrate as a sclerosing agent in humans should be evaluated.
比较兔胸腔内注射硝酸银和滑石粉悬液在12个月观察期内的胸膜固定术效果。
将兔随机分为两组，分别胸腔内注射2 mL 0.5%硝酸银或2 mL含400 mg/kg滑石粉的悬液。每组10只兔在胸腔内注射后1个月、2个月、4个月、6个月、8个月、10个月和12个月处死。根据大体胸膜固定程度以及显微镜下胸膜纤维化和炎症程度进行0至4级评分。
70只接受硝酸银注射的兔，其平均±标准误大体胸膜固定术评分为3.34±0.08，显著高于70只接受滑石粉注射兔的2.32±0.09分。除2个月时外，接受硝酸银注射的兔在各观察时间点的平均大体胸膜固定术评分均显著更高（p<0.05）。接受硝酸银注射的兔胸膜固定分布于整个胸腔，而接受滑石粉悬液注射的兔仅见于胸腔前部。在12个月观察期内，两个治疗组的大体胸膜固定术评分均无下降趋势。滑石粉在胸腔内的存留未导致慢性炎症改变，因为两组在所有观察时间点的炎症评分相似。硝酸银组显微镜下胸膜纤维化评分随时间有下降趋势，而滑石粉悬液组则无。
兔胸腔内注射2 mL 0.5%硝酸银比注射400 mg/kg滑石粉悬液产生更好的胸膜固定效果。硝酸银诱导的胸膜固定至少持续1年。应评估硝酸银作为硬化剂在人体中的疗效。
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