Morimoto Yoshihito, Takei Hidefumi, Tachibana Keisei, Nakazato Yoko, Tanaka Ryota, Nagashima Yasushi, Watanabe Kazuhiro, Seki Reisuke, Shinohara Takao, Kondo Haruhiko
Education and Research Center for Clinical Pharmacy, Showa Pharmaceutical University, Japan.
Department of General Thoracic Surgery, Kyorin University Hospital, Japan.
Intern Med. 2018 Jun 15;57(12):1697-1702. doi: 10.2169/internalmedicine.9637-17. Epub 2018 Feb 9.
Objective In Japan, pleurodesis is often performed using OK-432. However, OK-432 may cause severe chest pain and fever. The risk factors for these complications are unclear. The aim of this study was to identify the risk factors for chest pain and fever caused by pleurodesis with OK-432. Methods The clinical data of 94 patients who underwent pleurodesis with OK-432 were retrospectively analyzed. Patients who developed chest pain (indicated by a record of rescue pain medication) and/or fever (a recorded temperature of >38°C) were identified. A logistic regression analysis was performed to determine the risk factors for these complications. Results Rescue medication for chest pain was required by 43.6% of the patients and 40.4% developed pyrexia after pleurodesis with OK-432. The univariate analysis showed that the likelihood of requiring rescue medication for chest pain was significantly increased in patients of <70 years of age (p=0.028) and in those who were not premedicated with a nonsteroidal anti-inflammatory drug (NSAID; p=0.003). Age <70 years (adjusted odds ratio 2.97, 95% confidence interval 1.10-8.00, p=0.031) and a lack of premedication with an NSAID (adjusted odds ratio 4.21, 95% confidence interval 1.47-12.04, p=0.007) remained significant factors in a multivariate analysis. The absence of NSAID premedication was the only statistically significant risk factor for fever in the univariate analysis (p=0.034). The multivariate analysis revealed no significant risk factors for fever. Conclusion The results of the present study suggest that premedication with an NSAID might be useful for preventing the chest pain caused by pleurodesis with OK-432. Furthermore, caution is advised when managing chest pain in adults of <70 years of age. Prospective studies should be performed to further investigate this issue.
目的 在日本，常使用OK-432进行胸膜固定术。然而，OK-432可能会导致严重胸痛和发热。这些并发症的危险因素尚不清楚。本研究的目的是确定OK-432胸膜固定术所致胸痛和发热的危险因素。方法 回顾性分析94例行OK-432胸膜固定术患者的临床资料。确定出现胸痛（有使用止痛急救药物记录）和/或发热（记录体温>38°C）的患者。进行逻辑回归分析以确定这些并发症的危险因素。结果 43.6%的患者需要使用胸痛急救药物，40.4%的患者在OK-432胸膜固定术后出现发热。单因素分析显示，年龄<70岁的患者（p=0.028）和未使用非甾体抗炎药（NSAID）进行预处理的患者（p=0.003）需要胸痛急救药物的可能性显著增加。年龄<70岁（调整比值比2.97，95%置信区间1.10-8.00，p=0.031）和未使用NSAID进行预处理（调整比值比4.21，95%置信区间1.47-12.04，p=0.007）在多因素分析中仍是显著因素。单因素分析中，未使用NSAID预处理是发热唯一具有统计学意义的危险因素（p=0.034）。多因素分析未发现发热的显著危险因素。结论 本研究结果表明，使用NSAID进行预处理可能有助于预防OK-432胸膜固定术所致的胸痛。此外，对于年龄<70岁的成年人，在处理胸痛时应谨慎。应进行前瞻性研究以进一步探讨该问题。
