Heimes Jessica, Copeland Hannah, Lulla Aditya, Duldulao Marjulin, Bahjri Khaled, Zaheer Salman, Wallen Jason M
Department of Thoracic and Cardiothoracic Surgery, Loma Linda University Medical Center, Loma Linda, California, USA.
Cardiothoracic Surgery Richmond, McGuire Veterans Affairs Medical Center, Richmond, VA, USA.
J Thorac Dis. 2017 May;9(5):1310-1316. doi: 10.21037/jtd.2017.04.56.
To determine the efficacy of thrombolytics for the management of complex pleural fluid collections.
We reviewed patients that received alteplase for persistent loculated pleural fluid collections after simple tube drainage between July 01, 2007 and November 01, 2012. Our alteplase protocol is 6 mg of alteplase in 50 mL of normal saline injected into the pleural chest tube. The chest tube is clamped for four hours and then opened. Normally this is repeated daily for 2 to 3 days (d).
One hundred and three [103] patients were identified with 110 interventions. Sixty-eight (66%) of the patients were male, with ages ranging from 20-91 years (y), mean 57.2 y. Twenty (18.2%) patients were trauma patients, 60 (55%) had hypertension and 32 (35%) were smokers. Most patients had one of the following diagnoses: 79.6% (82/110) loculated pleural fluid collection as a result of an empyema or 20.4% (21/110) retained hemothorax. The mean time from diagnosis to alteplase treatment for a hemothorax was 12.8 days (range, 1-32 days) and 16.2 days (range, 4-48 days) for an empyema. The mean duration of therapy was 2.2±1.4 days (1-11 days). The time from alteplase to chest tube removal was 4.5 days (1-21 days). Eleven of 103 (10.7%) patients required surgery including 3 video assisted decortications. The others had adequate radiographic resolution. Seventeen patients (16.5%) died, in the hospital of: sepsis, respiratory failure, aortic injury, and cardiac arrest.
Alteplase therapy is an effective alternative to surgery in most complex pleural fluid collections.
确定溶栓剂治疗复杂性胸腔积液的疗效。
我们回顾了2007年7月1日至2012年11月1日期间在单纯胸腔置管引流后因持续性包裹性胸腔积液接受阿替普酶治疗的患者。我们的阿替普酶方案是将6毫克阿替普酶溶于50毫升生理盐水中注入胸腔引流管。胸腔引流管夹闭4小时后放开。通常每天重复此操作2至3天。
共确定103例患者接受了110次干预。68例（66%）患者为男性，年龄范围为20至91岁，平均57.2岁。20例（18.2%）患者为创伤患者，60例（55%）患有高血压，32例（35%）为吸烟者。大多数患者有以下诊断之一：79.6%（82/110）因脓胸导致的包裹性胸腔积液或20.4%（21/110）为残留血胸。血胸从诊断到接受阿替普酶治疗的平均时间为12.8天（范围1至32天），脓胸为16.2天（范围4至48天）。平均治疗持续时间为2.2±1.4天（1至11天）。从使用阿替普酶到拔除胸腔引流管的时间为4.5天（1至21天）。103例患者中有11例（10.7%）需要手术，其中3例为电视辅助胸膜剥脱术。其他患者影像学上有足够的改善。17例患者（16.5%）在医院死亡，死因包括败血症、呼吸衰竭、主动脉损伤和心脏骤停。
在大多数复杂性胸腔积液中，阿替普酶治疗是手术的有效替代方法。
