Henke C A, Leatherman J W
Department of Medicine, University of Minnesota, Minneapolis 55455.
Am Rev Respir Dis. 1992 Mar;145(3):680-4. doi: 10.1164/ajrccm/145.3.680.
Adequate pleural drainage is believed to be an essential component of the management of low pH-low glucose parapneumonic effusion. Parapneumonic effusions may become loculated rapidly, preventing adequate drainage with a single chest tube. Administration of intrapleural streptokinase may be effective in promoting drainage for loculated, nonpurulent low pH-low glucose parapneumonic effusions when fibrin adhesions may not yet be organized. Intrapleural streptokinase was used in 12 patients with relatively large, symptomatic, loculated, nonpurulent parapneumonic effusions in whom the initial thoracentesis demonstrated a pH less than or equal to 7.0 and/or glucose less than or equal to 40 mg/dl, and when inadequate drainage was demonstrated roentgenographically despite tube thoracostomy. Mean pleural fluid WBC was 9,750/mm3 (range, 1 to 27 K), and pleural fluid glucose and pH were 33 +/- 21 mg/dl and 6.95 +/- 0.19, respectively. A solution of streptokinase, 250,000 units in normal saline, was given intrapleurally via the chest tube. Effectiveness of intrapleural streptokinase was assessed radiographically and by monitoring the volume of fluid drained from the chest tube after streptokinase instillation. A greater than 50% improvement in the CXR was seen in nine of 12 patients after intrapleural administration of streptokinase. The volume of fluid out in the first 48 h post-streptokinase was 849 +/- 836 ml (range, 100 to 3,000). In addition, clinical improvement (decreased chest discomfort, less dyspnea, or reduced fever) was noted in eight of 12 patients after streptokinase treatment. We conclude that intrapleural administration of streptokinase is an effective adjunct to the management of nonpurulent, loculated parapneumonic effusions that may reduce the need for multiple chest tubes or surgical drainage.
充分的胸腔引流被认为是低pH值-低葡萄糖类肺炎性胸腔积液治疗的重要组成部分。类肺炎性胸腔积液可能迅速形成分隔，导致单根胸管无法充分引流。当纤维蛋白粘连尚未形成时，胸腔内注射链激酶可能对促进分隔的、非脓性的低pH值-低葡萄糖类肺炎性胸腔积液的引流有效。12例有相对较大、有症状、分隔的、非脓性类肺炎性胸腔积液的患者使用了胸腔内链激酶，这些患者最初胸腔穿刺显示pH值小于或等于7.0和/或葡萄糖小于或等于40mg/dl，且尽管进行了胸腔闭式引流术，但影像学检查显示引流不充分。胸腔积液白细胞平均计数为9750/mm³（范围为1至27K），胸腔积液葡萄糖和pH值分别为33±21mg/dl和6.95±0.19。将25万单位链激酶溶于生理盐水制成的溶液通过胸管注入胸腔。通过影像学检查以及监测链激酶注入后从胸管引出的液体量来评估胸腔内链激酶的有效性。胸腔内注射链激酶后，12例患者中有9例胸部X线片改善超过50%。链激酶注射后最初48小时引出的液体量为849±836ml（范围为100至3000ml）。此外，12例患者中有8例在链激酶治疗后临床症状改善（胸部不适减轻、呼吸困难减轻或发热减退）。我们得出结论，胸腔内注射链激酶是治疗非脓性、分隔类肺炎性胸腔积液的有效辅助方法，可能减少对多根胸管或手术引流的需求。
