Pediatric Surgeon, Conceição Children's Hospital and Mãe de Deus University Hospital, Canoas, Brazil.
Department of Surgery, School of Medicine, Federal University of Rio Grande do Sul (UFRGS). Pediatric Surgeon, Head of Pediatric Surgery Service, Pediatric Thoracic Surgery Unit, Clinical Hospital of Porto Alegre (HCPA), Brazil.
Pulm Pharmacol Ther. 2019 Apr;55:1-4. doi: 10.1016/j.pupt.2019.01.001. Epub 2019 Jan 14.
Adjunctive intrapleural fibrinolytic is an option to treat empyema at fibrinopurulent stage, but there is controversy about which should be use. Our objective is to evaluate the action of alteplase and/or desoxyribonuclease at physical and chemical properties in vitro pus derived from an experimental induced empyema in rats.
Streptococcus pneumoniae was introduced into the pleural cavity by thoracentesis through pleural pressure monitor. Animals were euthanized after 24 h, with macroscopic thoracic evaluation and measurement of amount of intrapleural liquid that was posteriorly stored at -80 °C. Selected samples were randomly distributed into four groups, then thawed at room temperature before exposure to one of the following: G1 = alteplase (n = 12), G2 = DNase (n = 12), G3 = alteplase + DNase (n = 12), or G4 = saline (n = 6). The mean molecular size in the fluid portion of the empyema was evaluated using dynamic light scattering; viscosity of the empyema fluid was measured using the drip method.
Macroscopic showed purulent liquid, with fibrin and septation, with mean volume of 4.16 ml (0.5-8 ml). All samples were culture-positive for Streptococcus pneumoniae. Comparing with control, all experimental groups presented reduction of larger than 135 nm molecular size, but there was only significant difference with alteplase (p = 0,02). Viscosity reduced at all experimental groups, but increased at control. DNase group presented negative median (-5 mPa/s) of viscosity, and differed significantly from that observed in the control group (p = 0.04).
Alteplase, DNase and alteplase + DNase changed significantly physical and chemical properties of experimental empyema at fibrinopurulent phase: alteplase reduced molecular size larger than 135 nm and DNase reduced viscosity.
辅助性胸腔内纤维蛋白溶解是治疗纤维脓性阶段脓胸的一种选择，但在选择哪种药物方面存在争议。我们的目的是评估链激酶和/或脱氧核糖核酸酶在体外物理和化学性质方面对大鼠实验性脓胸产生的脓性胸腔积液的作用。
通过胸腔压力监测经胸腔穿刺将肺炎链球菌引入胸腔。24 小时后，通过大体胸部评估和测量胸腔内液体量来处死动物，这些液体随后储存在-80°C。选择的样本随机分为四组，然后在室温下解冻，然后暴露于以下条件之一：G1=链激酶（n=12），G2=DNase（n=12），G3=链激酶+DNase（n=12）或 G4=生理盐水（n=6）。使用动态光散射评估胸腔积液中流体部分的平均分子大小；使用滴注法测量脓性胸腔积液的粘性。
大体观察结果为脓性液体，有纤维蛋白和分隔，平均体积为 4.16ml（0.5-8ml）。所有样本的培养均为肺炎链球菌阳性。与对照组相比，所有实验组的大于 135nm 的分子大小均减少，但只有链激酶组有显著差异（p=0.02）。所有实验组的粘性均降低，但对照组粘性增加。DNase 组的粘性呈负中位数（-5mPa/s），与对照组差异有统计学意义（p=0.04）。
链激酶、DNase 和链激酶+DNase 显著改变了纤维脓性阶段实验性脓胸的物理和化学性质：链激酶降低了大于 135nm 的分子大小，DNase 降低了粘性。
