Ekingen Gülşen, Güvenç Bekir H, Sözübir Selami, Tuzlaci Ayşe, Senel Ufuk
Department of Pediatric Surgery, Kocaeli University School of Medicine, 41900 Kocaeli, Turkey.
Eur J Cardiothorac Surg. 2004 Sep;26(3):503-7. doi: 10.1016/j.ejcts.2004.05.032.
Proper antibiotic treatment and adequate pleural drainage is essential in successful management of pleural effusions. In complicated effusions the increased production of fibrin results in formation of loculations and septations within the thoracic cavity, leading ineffective chest tube drainage. Intrapleural fibrinolytic agents are employed to avoid thoracotomy in such complicated pleural effusions. Our study reviews the results of streptokinase treatment in children with pleural effusion.
Thirty-two patients with parapneumonic pleural effusions were admitted to our hospital. The patients beyond the exudative stage were divided into two groups according to the initial radiological findings and biochemical parameters of pleural fluid. Intrapleural streptokinase treatment was started in an average of 2 days following initial chest tube placement in both Group I (14 patients) in fibrino-purulent phase with pleural effusion and fluid volume estimated to be larger than one-third of the involved lung and Group II (18 patients) with additional findings in radiological examination regarding the presence of air-fluid levels, multiple loculations, necrotic debris and pleural thickening. The effectiveness of therapy was assessed by monitoring the volume of the fluid, the level of LDH, glucose, pH and by radiological imaging, pre- and post-instillation.
There was statistically significant difference between two groups according to date of admission (6.8 vs 10.4 days), mean of total pleural fluid drainage before (106.9 vs 309.7 ml) and after (258.9 vs 511.2 ml) SK treatment, mean of total number of instillations (2.1 vs 3.6) required and total length of hospital stay (16.6 vs 22.4 days). There was a significant difference regarding pleural chemical analysis. Finally, surgical intervention was necessary in six intractable cases, all of which initially presented a significant small amount of pleural drainage in volume when compared to rest of the patients. The overall success rate of our treatment was calculated as 96% for G-I and 72.2% for G-II cases.
Intrapleural streptokinase is an effective and safe adjunct in facilitating drainage in early and late stage II empyemas. A tendency of decreased rate of drainage besides persisting fever and respiratory symptoms, despite fibrinolytic treatment may be a clue for early surgical intervention.
恰当的抗生素治疗和充分的胸腔引流是成功处理胸腔积液的关键。在复杂性胸腔积液中,纤维蛋白生成增加会导致胸腔内形成分隔和多房,致使胸腔闭式引流效果不佳。胸腔内使用纤维蛋白溶解剂可避免在这类复杂性胸腔积液中进行开胸手术。我们的研究回顾了链激酶治疗儿童胸腔积液的结果。
32例肺炎旁胸腔积液患儿入住我院。渗出期后的患儿根据胸腔积液的初始影像学表现和生化参数分为两组。I组(14例)为纤维脓性期胸腔积液且估计积液量大于受累肺的三分之一,II组(18例)在影像学检查中有气液平面、多个分隔、坏死碎片和胸膜增厚等额外表现,两组均在首次放置胸腔闭式引流管后平均2天开始胸腔内注射链激酶治疗。通过监测治疗前后胸腔积液量、乳酸脱氢酶(LDH)水平、葡萄糖、pH值以及影像学检查来评估治疗效果。
两组在入院日期(6.8天对10.4天)、链激酶治疗前(106.9毫升对309.7毫升)和治疗后(258.9毫升对511.2毫升)胸腔积液总引流量的均值、所需注射总次数的均值(2.1次对3.6次)以及住院总时长(16.6天对22.4天)方面存在统计学显著差异。胸腔化学分析也有显著差异。最后,6例难治性病例需要手术干预,与其他患者相比,所有这些病例最初胸腔引流量均显著较少。I组治疗的总体成功率计算为96%,II组为72.2%。
胸腔内注射链激酶是促进II期早期和晚期脓胸引流的一种有效且安全的辅助方法。尽管进行了纤维蛋白溶解治疗,但除持续发热和呼吸道症状外引流率下降的趋势可能是早期手术干预的线索。