Ho Man-Yau, Chen Hsiang-Yin, Yen Yu-Hsuan, Yang Yao-Shun, Lien Shao-Hung
Department of Pediatrics, Taipei Medical University - Wanfang Hospital, Taipei, Taiwan.
Acta Paediatr Taiwan. 2007 Sep-Oct;48(5):251-6.
Pleuritis with empyema is a serious complication of bacterial pneumonia, which often causes substantial morbidity and mortality among pediatric patients. Currently percutaneous catheter drainage is the mainstay therapy for loculated empyema. Intrapleural instillation of streptokinase, urokinase, and recombinant tissue plasminogen activator has been reported to facilitate the drainage of viscous fluid and fibrinous debris or multiple loculations from the pleural space of such patients.
In this study, we compared with the treatments of pleural empyema by instillation of streptokinase through the chest tube and using the conventional chest tube drainage alone.
We collected 21 cases from 1999 through 2005. The results of the study showed that streptokinase (SK) group patients revealed a larger volume of drainage in the beginning days of the instillation and required fewer days of drainage than tube drainage (T) group patients [8 (4.5 - 10) days vs. 16 (5.8 - 20.3) days, p = 0.02]; that the SK group patients required average 2.6 instillations. The SK patients had a shorter febrile course than the T group [12.5 (9.5 - 15.5) days vs. 16 (9.5 - 22.5) days, p = 0.14]. None of the SK patients needed additional video-assisted thoracoscopic surgery (VATS) whereas 5 patients in the T group did. The length of hospitalization in the SK group was 21.5 days and the T group patients was 24 days.
Intrapleural instillation of streptokinase seldom caused clinical adverse effect and appears to be a safe adjunctive therapy to facilitate the drainage of empyema in pediatric patients. Further studies with better research design to compare the fibrinolytic agent instillation and the VATS as the first step treatment of childhood empyema are needed.
胸膜炎伴脓胸是细菌性肺炎的一种严重并发症，在儿科患者中常导致显著的发病率和死亡率。目前，经皮导管引流是局限性脓胸的主要治疗方法。据报道，胸膜腔内注入链激酶、尿激酶和重组组织型纤溶酶原激活剂有助于从此类患者的胸膜腔引流粘性液体、纤维蛋白碎片或多个分隔腔。
在本研究中，我们比较了通过胸管注入链激酶与单纯使用传统胸管引流治疗胸膜脓胸的效果。
我们收集了1999年至2005年的21例病例。研究结果显示，链激酶（SK）组患者在注入开始的几天内引流量更大，引流天数比单纯胸管引流（T）组患者少[8（4.5 - 10）天对16（5.8 - 20.3）天，p = 0.02]；SK组患者平均需要注入2.6次。SK组患者发热病程比T组短[12.5（9.5 - 15.5）天对16（9.5 - 22.5）天，p = 0.14]。SK组患者均无需额外的电视辅助胸腔镜手术（VATS），而T组有5例患者需要。SK组的住院时间为21.5天，T组患者为24天。
胸膜腔内注入链激酶很少引起临床不良反应，似乎是一种安全的辅助治疗方法，有助于儿科患者脓胸的引流。需要进一步进行设计更好的研究，以比较纤溶药物注入与VATS作为儿童脓胸第一步治疗方法的效果。
