Kobr Jiri, Pizingerova Katerina, Sasek Lumir, Fremuth Jiri, Siala Konrad, Racek Jaroslav
Department of Paediatrics-PICU, Faculty of Medicine in Pilsen and Faculty Hospital in Pilsen, Czech Republic.
Pediatr Int. 2010 Jun;52(3):453-8. doi: 10.1111/j.1442-200X.2009.03006.x. Epub 2009 Nov 16.
The aim of this study was to improve the efficacy of treatment of complicated pleural effusions.
In this prospective study, 76 consecutive children (average age 5.0 +/- 4.14 years) fulfilling the required classification criteria were duly treated with chest tube placement and divided into two groups depending on the presence of encapsulated or non-encapsulated effusions. Treatment of the former group was supplemented by intrapleural fibrinolysis. The effectiveness of treatment was assessed in terms of chest tube dwell-time and total length of hospitalization. Regression analysis was performed using independent factors that were associated with these dependent factors. Value differences for P < 0.05 were considered significant.
The ultrasound pleural distance and lactic-dehydrogenase content in the pleural fluid was significantly associated with the length of treatment (P < 0.01). Improved response to treatment, reduced duration of hospitalization (9.2 +/- 1.9 vs 11.5 +/- 0.9; P < 0.01) and tube dwell-time (7.6 +/- 1.3 vs 9.5 +/- 0.9; P < 0.01) was achieved in the intrapleural-fibrinolysis-treated group (n= 38) compared with controls (n= 38), with virtually the same total tube output (606.1 +/- 257.5 vs 673.1 +/- 347.4; P= 0.175). All patients were completely cured. Following 104 applications of the fibrinolytic agent there was one change in coagulation parameters: hypofibrinogenemia (in 1%).
The authors recommend intrapleural fibrinolysis as an effective and safe alternative treatment strategy in treating encapsulated pleural effusions in children.
本研究旨在提高复杂性胸腔积液的治疗效果。
在这项前瞻性研究中，76名符合所需分类标准的连续儿童（平均年龄5.0±4.14岁）接受了胸腔置管治疗，并根据有无包裹性胸腔积液分为两组。前一组的治疗辅以胸膜腔内纤维蛋白溶解治疗。根据胸腔置管时间和住院总时长评估治疗效果。使用与这些因变量相关的自变量进行回归分析。P<0.05的数值差异被认为具有统计学意义。
胸腔积液中的超声胸膜距离和乳酸脱氢酶含量与治疗时长显著相关（P<0.01）。与对照组（n=38）相比，接受胸膜腔内纤维蛋白溶解治疗的组（n=38）治疗反应改善，住院时间缩短（9.2±1.9天对11.5±0.9天；P<0.01），置管时间缩短（7.6±1.3天对9.5±0.9天；P<0.01），而总引流量几乎相同（606.1±257.5毫升对673.1±347.4毫升；P=0.175）。所有患者均完全治愈。在使用纤维蛋白溶解剂104次后，凝血参数有一项改变：低纤维蛋白原血症（1%）。
作者推荐胸膜腔内纤维蛋白溶解作为治疗儿童包裹性胸腔积液的一种有效且安全的替代治疗策略。
