Walker Charlotte A, Shirk Mary Beth, Tschampel Marva M, Visconti James A
Chalmers P Wylie Veterans Affairs Outpatient Clinic, Columbus, OH, USA.
Ann Pharmacother. 2003 Mar;37(3):376-9. doi: 10.1345/aph.1C248.
To report the intrapleural use of alteplase in a patient diagnosed with complicated pleural effusion (CPE).
A 62-year-old white woman admitted with respiratory distress and hypotension developed a right-sided multi-loculated pleural effusion. Thoracentesis and chest tube drainage were not successful in resolving the effusion. In an attempt to increase the drainage of the pleural effusion, alteplase 16 mg was administered into the pleural cavity via the chest tube on 6 consecutive days. As a result, the volume drained from the patient's chest tube increased, there was improvement on the chest X-ray, and she did not require surgical intervention.
While streptokinase and urokinase have been shown to be useful adjuncts to chest tube drainage in the treatment of complicated pleural effusion and empyema, there have been no reports on the use of intrapleural alteplase. This report demonstrates that intrapleural administration of alteplase is a useful adjunct to tube drainage in resolving CPE.
This patient's CPE resolved when intrapleural alteplase was used as an adjunct to chest tube drainage and antibiotics. Controlled trials need to be conducted to investigate fully the efficacy, dosing, and safety of intrapleural alteplase in the treatment of patients with CPE and empyema.
报告在一名被诊断为复杂性胸腔积液（CPE）的患者中胸膜腔内使用阿替普酶的情况。
一名62岁的白人女性因呼吸窘迫和低血压入院，出现右侧多房性胸腔积液。胸腔穿刺术和胸腔闭式引流未能成功消除积液。为增加胸腔积液的引流量，连续6天通过胸腔闭式引流管向胸腔内注入16毫克阿替普酶。结果，患者胸腔闭式引流管引出的液体量增加，胸部X线检查有所改善，且她无需手术干预。
虽然链激酶和尿激酶已被证明在治疗复杂性胸腔积液和脓胸时是胸腔闭式引流的有用辅助药物，但尚无关于胸膜腔内使用阿替普酶的报道。本报告表明，胸膜腔内注射阿替普酶是解决CPE时胸腔闭式引流的有用辅助方法。
当胸膜腔内阿替普酶作为胸腔闭式引流和抗生素的辅助药物使用时，该患者的CPE得到缓解。需要进行对照试验以全面研究胸膜腔内阿替普酶治疗CPE和脓胸患者的疗效、剂量和安全性。
