Jiang Chuan, Xie Meng, Cervellione Kelly, Thurm Craig
Department of Medicine-Division of Pulmonary Medicine, Jamaica Hospital Medical Center, Jamaica, NY, 11418, USA.
Department of Clinical Research, Jamaica Hospital Medical Center, Jamaica, NY, 11418, USA.
BMC Res Notes. 2020 Aug 3;13(1):368. doi: 10.1186/s13104-020-05210-2.
The use of intrapleural tissue plasminogen activator (tPA) and dornase alfa (DNase) is common in the management of pleural space infection. We review our experience with the efficacy and safety of this therapy. We performed a single center, retrospective study of consecutive patients with complicated parapneumonic effusion or empyema who received tPA/DNase therapy. Treatment success was defined as radiographic and clinical improvement in pleural space infection that precluded the need for surgical intervention, and the absence of mortality related to pleural infection.
Fifty-six patients received concurrent once daily tPA/DNase therapy (median 3 days) from July 2014 to July 2019. Fifty-two patients (92.9%) had treatment success. Median duration of chest tube therapy was 10 days and length of stay was 15 days. Significant pleural bleeding requiring transfusion therapy occurred in five patients (8.9%). Of these, three patients (5.4%) required operative intervention. Concurrent once daily administration of tPA/DNase in patients with pleural infection yielded comparable rates of treatment success as compared to twice daily concurrent or sequential administration. However, adverse events highlight potential safety concerns with using once daily concurrent administration of tPA/DNAse.
胸膜腔内使用组织型纤溶酶原激活剂（tPA）和脱氧核糖核酸酶（DNase）在胸膜腔感染的治疗中很常见。我们回顾了我们在这种治疗的疗效和安全性方面的经验。我们对连续接受tPA/DNase治疗的复杂性肺炎旁胸腔积液或脓胸患者进行了一项单中心回顾性研究。治疗成功定义为胸膜腔感染在影像学和临床上有所改善，无需进行手术干预，且无与胸膜感染相关的死亡。
2014年7月至2019年7月，56例患者接受了每日一次的tPA/DNase联合治疗（中位时间为3天）。52例患者（92.9%）治疗成功。胸腔闭式引流治疗的中位持续时间为10天，住院时间为15天。5例患者（8.9%）发生了需要输血治疗的严重胸膜出血。其中，3例患者（5.4%）需要手术干预。与每日两次联合或序贯给药相比，胸膜感染患者每日一次同时给予tPA/DNase的治疗成功率相当。然而，不良事件凸显了每日一次同时使用tPA/DNAse的潜在安全问题。
