胸膜腔内注射尿激酶治疗儿童脓胸的随机试验
Randomised trial of intrapleural urokinase in the treatment of childhood empyema.
作者信息
Thomson A H, Hull J, Kumar M R, Wallis C, Balfour Lynn I M
机构信息
Department of Paediatrics, John Radcliffe Hospital, Oxford, UK.
出版信息
Thorax. 2002 Apr;57(4):343-7. doi: 10.1136/thorax.57.4.343.
Abstract
BACKGROUND
The role of intrapleural fibrinolytic agents in the treatment of childhood empyema has not been established. A randomised double blind placebo controlled trial of intrapleural urokinase was performed in children with parapneumonic empyema.
METHODS
Sixty children (median age 3.3 years) were recruited from 10 centres and randomised to receive either intrapleural urokinase 40 000 units in 40 ml or saline 12 hourly for 3 days. The primary outcome measure was length of hospital stay after entry to the trial.
RESULTS
Treatment with urokinase resulted in a significantly shorter hospital stay (7.4 v 9.5 days; ratio of geometric means 1.28, CI 1.16 to 1.41 p=0.027). A post hoc analysis showed that the use of small percutaneous drains was also associated with shorter hospital stay. Children treated with a combination of urokinase and a small drain had the shortest stay (6.0 days, CI 4.6 to 7.8).
CONCLUSION
Intrapleural urokinase is effective in treating empyema in children and significantly shortens hospital stay.
摘要
背景
胸膜内纤维蛋白溶解剂在儿童脓胸治疗中的作用尚未明确。对肺炎旁胸腔积液患儿进行了一项胸膜内使用尿激酶的随机双盲安慰剂对照试验。
方法
从10个中心招募了60名儿童（中位年龄3.3岁），随机分为两组，分别每12小时接受40ml含40000单位尿激酶的胸腔内注射或生理盐水注射，共3天。主要结局指标是进入试验后的住院时间。
结果
尿激酶治疗使住院时间显著缩短（7.4天对9.5天；几何均数比为1.28，可信区间为1.16至1.41，p = 0.027）。事后分析表明，使用小型经皮引流管也与较短的住院时间相关。接受尿激酶和小型引流管联合治疗的儿童住院时间最短（6.0天，可信区间为4.6至7.8）。
结论
胸膜内尿激酶对治疗儿童脓胸有效，并显著缩短住院时间。
相似文献
1
Randomised trial of intrapleural urokinase in the treatment of childhood empyema.胸膜腔内注射尿激酶治疗儿童脓胸的随机试验
Thorax. 2002 Apr;57(4):343-7. doi: 10.1136/thorax.57.4.343.
2
Intrapleural urokinase in the management of parapneumonic empyema: a randomised controlled trial.胸膜腔内注射尿激酶治疗肺炎旁胸腔积液：一项随机对照试验。
Int J Clin Pract. 2001 Dec;55(10):658-60.
3
Comparison of urokinase and video-assisted thoracoscopic surgery for treatment of childhood empyema.尿激酶与电视胸腔镜手术治疗儿童脓胸的比较。
Am J Respir Crit Care Med. 2006 Jul 15;174(2):221-7. doi: 10.1164/rccm.200601-027OC. Epub 2006 May 4.
4
Use of urokinase in childhood pleural empyema.尿激酶在儿童胸腔积脓中的应用。
Pediatr Pulmonol. 2003 Jan;35(1):50-5. doi: 10.1002/ppul.10212.
5
Medical management of parapneumonic pleural disease.肺炎旁胸腔疾病的药物治疗
Pediatr Pulmonol. 2005 Feb;39(2):127-34. doi: 10.1002/ppul.20127.
6
Intrapleural urokinase treatment in children with complicated parapneumonic effusion.胸膜腔内注射尿激酶治疗儿童复杂性肺炎旁胸腔积液
Acta Paediatr Taiwan. 2006 Mar-Apr;47(2):61-6.
7
[Intrapleural urokinase in the treatment of parapneumonic effusions].[胸膜腔内注射尿激酶治疗肺炎旁胸腔积液]
An Pediatr (Barc). 2005 May;62(5):427-32. doi: 10.1157/13074616.
8
Intrapleural urokinase versus surgical management of childhood empyema.胸膜腔内尿激酶与儿童脓胸的手术治疗
J Paediatr Child Health. 2014 Oct;50(10):823-6. doi: 10.1111/j.1440-1754.2010.01931.x. Epub 2010 Dec 29.
9
Intrapleural urokinase in the treatment of complicated parapneumonic pleural effusions and empyema.胸膜腔内注射尿激酶治疗复杂性肺炎旁胸腔积液和脓胸。
Eur Respir J. 1996 Aug;9(8):1656-9. doi: 10.1183/09031936.96.09081656.
10
Urokinase versus VATS for treatment of empyema: a randomized multicenter clinical trial.尿激酶与电视辅助胸腔镜手术治疗脓胸的随机多中心临床试验
Pediatrics. 2014 Nov;134(5):e1301-7. doi: 10.1542/peds.2013-3935.
引用本文的文献
1
Intrapleural tissue plasminogen activator and deoxyribonuclease in complex pleural effusion and empyema, clinical outcomes, and predictors.胸膜内组织型纤溶酶原激活剂和脱氧核糖核酸酶治疗复杂性胸腔积液和脓胸的临床结局及预测因素
Ther Adv Respir Dis. 2025 Jan-Dec;19:17534666251343711. doi: 10.1177/17534666251343711. Epub 2025 May 30.
2
Comparison of Six versus Three Doses of Intrapleural Fibrinolytic Therapy in Children with Empyema: A Randomized Controlled Trial.六剂与三剂胸膜内纤维蛋白溶解疗法治疗儿童脓胸的比较：一项随机对照试验
Indian J Pediatr. 2025 Jan 31. doi: 10.1007/s12098-024-05405-6.
3
Contemporary use of fibrinolytics in the management of pediatric empyema.当代在小儿脓胸管理中纤溶药物的应用。
Pediatr Surg Int. 2024 Nov 4;40(1):289. doi: 10.1007/s00383-024-05868-w.
4
Management of pediatric pleural empyema: a national survey of pediatric surgeons in Brazil.小儿脓胸的处理：巴西小儿外科医生的全国性调查。
J Bras Pneumol. 2024 May 27;50(2):e20230318. doi: 10.36416/1806-3756/e20230318. eCollection 2024.
5
From Bedside to the Bench-A Call for Novel Approaches to Prognostic Evaluation and Treatment of Empyema.从床边到实验室——呼吁采用新方法进行脓胸的预后评估和治疗
Front Pharmacol. 2022 Jan 20;12:806393. doi: 10.3389/fphar.2021.806393. eCollection 2021.
6
Percutaneous management of complicated parapneumonic effusion and empyema after surgical tube thoracostomy failure in children: a retrospective study.经皮处理小儿外科胸腔引流术后失败并发复杂性脓胸和脓气胸：一项回顾性研究。
Diagn Interv Radiol. 2021 May;27(3):401-407. doi: 10.5152/dir.2021.20331.
7
Pleural empyema in children - benefits of primary thoracoscopic treatment.儿童胸腔积脓——初次胸腔镜治疗的益处
Wideochir Inne Tech Maloinwazyjne. 2021 Mar;16(1):264-272. doi: 10.5114/wiitm.2020.97443. Epub 2020 Nov 26.
8
Intra-pleural fibrinolytic therapy versus placebo, or a different fibrinolytic agent, in the treatment of adult parapneumonic effusions and empyema.胸膜内纤维蛋白溶解疗法与安慰剂或不同的纤维蛋白溶解剂在治疗成人肺炎旁胸腔积液和脓胸中的比较。
Cochrane Database Syst Rev. 2019 Oct 30;2019(10):CD002312. doi: 10.1002/14651858.CD002312.pub4.
9
Role of Intrapleural Urokinase in Empyema Thoracis.胸腔内尿激酶在脓胸中的作用。
Indian J Pediatr. 2019 Dec;86(12):1099-1104. doi: 10.1007/s12098-019-03060-w. Epub 2019 Oct 18.
10
Comparison of intrapleural use of urokinase and tissue plasminogen activator/DNAse in pleural infection.胸膜内使用尿激酶与组织纤溶酶原激活剂/脱氧核糖核酸酶治疗胸膜感染的比较
ERJ Open Res. 2019 Sep 10;5(3). doi: 10.1183/23120541.00084-2019. eCollection 2019 Jul.
本文引用的文献
1
THE EFFECT IN PATIENTS OF STREPTOCOCCAL FIBRINOLYSIN (STREPTOKINASE) AND STREPTOCOCCAL DESOXYRIBONUCLEASE ON FIBRINOUS, PURULENT, AND SANGUINOUS PLEURAL EXUDATIONS.链球菌纤维蛋白溶酶（链激酶）和链球菌脱氧核糖核酸酶对患者纤维蛋白性、脓性和血性胸腔渗出液的作用
J Clin Invest. 1949 Jan;28(1):173-90. doi: 10.1172/JCI102046.
2
Treatment of pleural empyema.胸膜腔积脓的治疗
J Paediatr Child Health. 2000 Aug;36(4):375-7. doi: 10.1046/j.1440-1754.2000.00525.x.
3
Computed tomography and ultrasound in parapneumonic effusions and empyema.计算机断层扫描和超声在肺炎旁胸腔积液和脓胸中的应用
Clin Radiol. 2000 Jul;55(7):542-7. doi: 10.1053/crad.1999.0480.
4
Thoracoscopic decortication as first-line therapy for pediatric parapneumonic empyema. A case series.胸腔镜剥脱术作为小儿肺炎旁胸腔积液的一线治疗方法：病例系列
Chest. 2000 Jul;118(1):24-7. doi: 10.1378/chest.118.1.24.
5
Effects of streptokinase and deoxyribonuclease on viscosity of human surgical and empyema pus.链激酶和脱氧核糖核酸酶对人体手术创口脓液及脓胸脓液粘度的影响。
Chest. 2000 Jun;117(6):1728-33. doi: 10.1378/chest.117.6.1728.
6
Evolving experience in the management of empyema thoracis.脓胸治疗的经验进展
Acta Paediatr. 2000 Apr;89(4):417-20. doi: 10.1080/080352500750028113.
7
Treatment of complicated pleural effusion with intracavitary urokinase in children.腔内注射尿激酶治疗儿童复杂性胸腔积液
Pediatr Pulmonol. 2000 Jun;29(6):438-42. doi: 10.1002/(sici)1099-0496(200006)29:6<438::aid-ppul5>3.0.co;2-n.
8
Image-guided percutaneous drainage of thoracic empyema: can sonography predict the outcome?影像引导下经皮胸腔积脓引流术：超声检查能否预测预后？
Eur Radiol. 2000;10(3):495-9. doi: 10.1007/s003300050083.
9
The in vitro efficacy of varidase versus streptokinase or urokinase for liquefying thick purulent exudative material from loculated empyema.与链激酶或尿激酶相比，玻璃酸酶在体外对溶解局限性脓胸的浓稠脓性渗出物的疗效。
Lung. 2000;178(1):13-8. doi: 10.1007/s004080000002.
10
Empyema thoracis: a role for open thoracotomy and decortication.脓胸：开胸手术和纤维板剥脱术的作用
Arch Dis Child. 1998 Dec;79(6):510-3. doi: 10.1136/adc.79.6.510.
Zotero 插件