Yao Chih-Ta, Wu Jing-Ming, Liu Ching-Chuan, Wu Ming-Ho, Chuang Hung-Yi, Wang Jieh-Neng
Department of Pediatrics, National Cheng Kung University Hospital, 138 Sheng-Li Road, Tainan 704, Taiwan, ROC.
Chest. 2004 Feb;125(2):566-71. doi: 10.1378/chest.125.2.566.
To evaluate the role of intrapleural streptokinase in the management of complicated parapneumonic effusions in children.
Prospective comparative study.
Cheng Kung University Hospital, a tertiary medical center in Tainan, Taiwan.
We enrolled as our prospective study group 20 consecutive children with complicated parapneumonic effusions who received intrapleural streptokinase treatment between August 2000 and July 2002. We also retrospectively analyzed a comparison group of 22 consecutive children with complicated parapneumonic effusions who received chest tube drainage without streptokinase treatment from January 1992 to July 2000. We then compared the clinical manifestations and outcome of these two patient groups. The patient population (21 boys and 21 girls) ranged in age from 9 to 130 months (mean age, 41.5 +/- 26.3 months [mean +/- SD]). The characters of pleural effusion showed no difference between the two groups. Nineteen patients had positive findings for Streptococcus pneumoniae, 2 patients had positive findings for Staphylococcus aureus, 2 patients had positive findings for Pseudomonas aeruginosa, and 19 patients had undetermined pathogens. All patients were treated with appropriate antibiotics.
More pleural fluid was drained from the streptokinase group than from the comparison group during streptokinase treatment (816 +/- 481 mL vs 279 +/- 238 mL, p < 0.01). The duration of fever after chest tube insertion was also significantly lower in the study group (5.3 +/- 3.1 days vs 7.9 +/- 4.6 days, p < 0.05). Only two patients in the streptokinase group required surgical intervention compared with nine patients in the comparison group (p < 0.05). No major side effects were noticed after streptokinase instillation.
Intrapleural fibrinolytic treatment with streptokinase is safe and effective, and it can obviate the need for surgery in most cases. The combination treatment should be attempted early on, when complicated parapneumonic effusion is first diagnosed.
评估胸膜腔内注射链激酶在儿童复杂性类肺炎性胸腔积液治疗中的作用。
前瞻性对照研究。
台湾台南成大医院，一家三级医疗中心。
我们将2000年8月至2002年7月期间连续收治的20例接受胸膜腔内注射链激酶治疗的复杂性类肺炎性胸腔积液患儿作为前瞻性研究组。我们还回顾性分析了1992年1月至2000年7月期间连续收治的22例接受胸腔闭式引流但未接受链激酶治疗的复杂性类肺炎性胸腔积液患儿组成的对照组。然后我们比较了这两组患者的临床表现及转归。患者群体（21名男孩和21名女孩）年龄范围为9至130个月（平均年龄41.5±26.3个月[平均值±标准差]）。两组胸腔积液特征无差异。19例肺炎链球菌检测呈阳性，2例金黄色葡萄球菌检测呈阳性，2例铜绿假单胞菌检测呈阳性，19例病原体未明确。所有患者均接受了适当的抗生素治疗。
链激酶治疗期间，链激酶组引出的胸腔积液比对照组多（816±481 mL对279±238 mL，p<0.01）。研究组胸腔闭式引流后发热持续时间也显著缩短（5.3±3.1天对7.9±4.6天，p<0.05）。链激酶组只有2例患者需要手术干预，而对照组有9例患者（p<0.05）。注射链激酶后未发现严重副作用。
胸膜腔内注射链激酶进行纤溶治疗安全有效，且在大多数情况下可避免手术。对于首次诊断为复杂性类肺炎性胸腔积液的患者，应尽早尝试联合治疗。
