Popowicz Natalia, Nash Michael, Lee Y C Gary
Pharmacy Department, Sir Charles Gairdner Hospital Perth, Australia.
Department of Respiratory Medicine, Sir Charles Gairdner Hospital Perth, Australia.
Respirol Case Rep. 2014 Dec;2(4):144-6. doi: 10.1002/rcr2.80. Epub 2014 Oct 10.
Intrapleural tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) therapy has recently been shown to improve outcomes in pleural infection in a randomized trial. Published literature, to date, consists of only ∼50 patients who had received tPA/DNase. Safety data of this regimen remain limited. Pleural contents often track along chest drains, but the effect of tPA/DNase on subcutaneous tissues is unknown. We report a patient treated in another center who was unintentionally administered up to six instillations of tPA (10 mg) and DNase (5 mg) intramuscularly via a malpositioned chest drain. The patient experienced minimal discomfort, and there were no signs of tissue inflammation or necrosis on computed tomography. No complications were detected over a 2-month follow-up. Upon transfer, a new pleural drain was inserted and tPA/DNase administered with clearance of his loculated complicated parapneumonic effusion. This case adds to the safety profile of intrapleural tPA/DNase therapy and highlights the importance of correct tube placement.
胸膜内组织型纤溶酶原激活剂（tPA）和脱氧核糖核酸酶（DNase）治疗最近在一项随机试验中显示可改善胸膜感染的预后。迄今为止，已发表的文献仅包含约50例接受tPA/DNase治疗的患者。该治疗方案的安全性数据仍然有限。胸膜内容物常沿胸腔引流管蔓延，但tPA/DNase对皮下组织的影响尚不清楚。我们报告了在另一个中心接受治疗的一名患者，该患者通过位置不当的胸腔引流管意外接受了多达6次的tPA（10毫克）和DNase（5毫克）肌肉注射。患者仅有轻微不适，计算机断层扫描未显示组织炎症或坏死迹象。在2个月的随访中未发现并发症。转院后，插入了新的胸膜引流管，并给予tPA/DNase治疗，其包裹性复杂性肺炎旁胸腔积液得以清除。该病例补充了胸膜内tPA/DNase治疗的安全性资料，并突出了正确置管的重要性。
