Division of Thoracic Surgery, Department of Surgery, University of Ottawa and the Ottawa Hospital, Ottawa, Canada.
BMJ Open. 2013 Jan 31;3(2). doi: 10.1136/bmjopen-2012-001887. Print 2013.
To assess risk factors associated with failure and bleeding in intrapleural fibrinolytic therapy (IPFT) for pleural effusions.
Retrospective case series.
Two tertiary-care centres in North America.
We identified 237 cases that received IPFT for the treatment of pleural effusions. Data for 227 patients were compiled including demographics, investigations, radiological findings pretherapy and post-therapy and outcomes.
Fibrinolytic therapy in the form of tissue plasminogen activator (t-PA) or streptokinase.
Success of therapy is defined as the presence of both clinical and radiological improvement leading to resolution. Failure was defined as persistence (ie, ineffective treatment) or complications requiring intervention from IPFT. Incidence of bleeding post-IPFT, identifying factors related to failure of therapy and bleeding.
IPFT was used in 237 patients with pleural effusions; 163 with empyema/complicated parapneumonic effusions, 32 malignant effusions and 23 with haemothorax. Overall, resolution was achieved in 80% of our cases. Failure occurred in 46 (20%) cases. Multivariate analysis revealed that failure was associated with the presence of pleural thickening (>2 mm) on CT scan (p=0.0031, OR 3, 95% CI 1.46 to 6.57). Bleeding was not associated with any specific variable in our study (antiplatelet medications, p=0.08).
Pleural thickening on a CT scan was found to be associated with failure of IPFT.
评估与胸腔内纤维蛋白溶解疗法（IPFT）治疗胸腔积液失败和出血相关的危险因素。
回顾性病例系列。
北美两家三级保健中心。
我们确定了 237 例接受 IPFT 治疗胸腔积液的病例。共收集了 227 例患者的数据，包括人口统计学、检查、治疗前和治疗后影像学发现和结果。
纤维蛋白溶解疗法采用组织型纤溶酶原激活剂（t-PA）或链激酶。
治疗成功定义为临床和影像学改善并存，导致胸腔积液消退。失败定义为持续存在（即治疗无效）或需要 IPFT 干预的并发症。IPFT 后出血的发生率、确定与治疗失败和出血相关的因素。
IPFT 用于 237 例胸腔积液患者；163 例脓胸/复杂类肺炎性胸腔积液，32 例恶性胸腔积液，23 例血胸。总体而言，80%的病例达到了缓解。46 例（20%）发生治疗失败。多变量分析显示，CT 扫描上存在胸腔增厚（>2 毫米）与失败相关（p=0.0031，OR 3，95%CI 1.46 至 6.57）。在我们的研究中，出血与任何特定变量均无关（抗血小板药物，p=0.08）。
CT 扫描上胸腔增厚与 IPFT 失败相关。
