Bouros Demosthenes, Tzouvelekis Argyris, Antoniou Katerina M, Heffner John E
Department of Pneumonology, Medical School University of Thrace, Alexandroupolis 68100, Greece.
Pulm Pharmacol Ther. 2007;20(6):616-26. doi: 10.1016/j.pupt.2006.08.001. Epub 2006 Sep 5.
Pneumonia with secondary pleural infection causes considerable morbidity and mortality. Intrapleural instillation of fibrinolytic agents to dissolve fibrinous adhesions is intended to improve pleural fluid drainage and prevent pleural loculations. In the last 20 years their application in the every day clinical practice has dragged much of attention and several studies have supported their use in the management of parapneumonic pleural effusions (PPE) and pleural empyema (PE). However, recent published data cast doubt on the effectiveness of intrapleural fibrinolytic agents in promoting drainage of infected pleural effusions. Pending future clinical trials, fibrinolytic therapy may be used selectively in patients who fail drainage with appropriately sized, image-guided chest tubes if reasons exist to delay or avoid definitive surgical drainage. The scope of this article is to systematically review evidence for the efficacy of intrapleural fibrinolytic therapy in the treatment of PPE and PE with emphasis on controlled trials and present some of the future perspectives.
肺炎合并继发性胸膜感染会导致相当高的发病率和死亡率。胸腔内注入纤维蛋白溶解剂以溶解纤维性粘连，旨在改善胸腔积液引流并防止胸膜腔分隔。在过去20年中，它们在日常临床实践中的应用引起了广泛关注，多项研究支持其用于治疗类肺炎性胸腔积液（PPE）和胸膜脓胸（PE）。然而，最近发表的数据对胸腔内纤维蛋白溶解剂促进感染性胸腔积液引流的有效性提出了质疑。在未来的临床试验之前，如果有理由延迟或避免确定性手术引流，对于使用适当尺寸的影像引导胸腔引流管引流失败的患者，可选择性地使用纤维蛋白溶解疗法。本文的范围是系统回顾胸腔内纤维蛋白溶解疗法治疗PPE和PE疗效的证据，重点是对照试验，并介绍一些未来的观点。
