Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, France.
Aix-Marseille University, Marseille, France.
Clin Respir J. 2021 Oct;15(10):1097-1103. doi: 10.1111/crj.13415. Epub 2021 Aug 11.
Despite advances in the treatment of pleural infection, up to 20% of patients die. So far, studies assessing the role of intrapleural saline lavage for the management of all stage pleural infections are very scarce, usually excluding patients with cancer.
The method used was a retrospective cohort study including pleural empyema managed with a pleural lavage of saline solution through a small-bore chest tube. The primary outcome was the rate of failure at 3 months (surgical referral or additional pleural manoeuver due to recurrent infection or all-cause mortality). Secondary outcomes were hospital stay, the change of the chest radiograph and inflammatory biomarkers, and complications.
Thirty patients with pleural empyema were included, 11 (36.7%) with an active cancer. The overall rate of failure at 3 months was 13.3% (surgical referral = 0; additional pleural manoeuver = 3; mortality = 1). Median length of pleural lavage and hospital stay were, respectively, 14 days (7-28) and 17 days (11-42). Inflammatory markers and size of the effusion on chest radiograph significantly decreased for Day 0 to Day 14. No chest tube blockade was reported, but seven (23.3%) accidentally withdrew. No other side effects were reported.
Intrapleural saline lavage is efficient and safe for the management of pleural empyema, even in severe status patients with cancer, at the cost of a prolonged hospitalization.
尽管在胸膜感染的治疗方面取得了进展，但仍有 20%的患者死亡。迄今为止，评估胸腔内生理盐水灌洗在所有阶段胸膜感染治疗中作用的研究非常稀缺，通常排除癌症患者。
该方法采用回顾性队列研究，包括通过小口径胸腔管进行盐水胸膜灌洗来治疗脓胸。主要结局是 3 个月时的失败率（因再次感染或全因死亡率而转诊手术或再次进行胸膜操作）。次要结局是住院时间、胸部 X 线片和炎症生物标志物的变化以及并发症。
共纳入 30 例脓胸患者，其中 11 例（36.7%）患有活动性癌症。3 个月时的总失败率为 13.3%（转诊手术=0；再次进行胸膜操作=3；死亡=1）。胸膜灌洗和住院的中位时间分别为 14 天（7-28）和 17 天（11-42）。炎症标志物和胸部 X 线片中胸腔积液的大小在第 0 天至第 14 天显著下降。未报告胸腔引流管堵塞，但有 7 例（23.3%）意外拔出。未报告其他副作用。
即使在癌症严重的患者中，胸腔内生理盐水灌洗在治疗脓胸方面也是有效且安全的，但会延长住院时间。
