Department of Pulmonary and Critical Care Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, NY, 12208, USA.
Department of Pulmonary and Critical Care, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI, 53226, USA.
Pulm Pharmacol Ther. 2021 Dec;71:102081. doi: 10.1016/j.pupt.2021.102081. Epub 2021 Sep 24.
Multiple studies describing the benefits of intrapleural fibrinolytic over placebo and DNase therapy have been published, but few have been published on intrapleural fibrinolytic and DNase therapy.
Our meta-analysis aims to compare the outcomes of surgical intervention, mortality, and hospital length of stay between intrapleural fibrinolytic and DNase therapy with either intrapleural fibrinolytic or DNase therapy alone in patients with pleural space infections.
We searched Pubmed, EMBASE, Web of Science, and Cochrane library databases for observational studies and randomized controlled trials (RCTs) containing comparative data for hospitalized adults and children with pleural infections receiving intrapleural therapy of fibrinolytic and DNase versus those receiving intrapleural fibrinolytic or DNase alone. Meta-analysis was performed using the Review Manager software, and heterogeneity was tested using I statistics.
A total of 2 cohorts and 2 RCTs involving 362 adult and children was included. There was significant reduction in surgical intervention requirement among patients who received intrapleural fibrinolytic and DNase (OR 0.30; 95% CI 0.11-0.83; I = 31%; P = 0.02) than those receiving either intrapleural fibrinolytic or DNase alone. No difference was observed for mortality (OR 0.72; 95% CI 0.31-1.71; I = 0%; P = 0.46) and complication rates (OR 3.09; 95% CI 0.75-12,74; I = 54%; P = 0.12). The hospital length of stay (mean 13.70 vs. 16.67 days; P = 0.19) and duration of chest tube drainage (mean 6.47 vs. 6.30 days; P = 0.58) was similar between the two groups.
Combination of intrapleural fibrinolytic and DNase, compared to single-agent intrapleural therapy alone, is associated with a lesser need for surgical interventions. However, no difference was found in mortality, hospital length of stay, and chest tube drainage duration.
已经发表了多项描述胸腔内纤维蛋白溶解酶优于安慰剂和 DNA 酶治疗效果的研究，但关于胸腔内纤维蛋白溶解酶和 DNA 酶联合治疗与单独使用胸腔内纤维蛋白溶解酶或 DNA 酶治疗胸腔间隙感染的研究较少。
我们的荟萃分析旨在比较胸腔内纤维蛋白溶解酶和 DNA 酶联合治疗与单独使用胸腔内纤维蛋白溶解酶或 DNA 酶治疗胸腔间隙感染患者的手术干预、死亡率和住院时间的结局。
我们在 Pubmed、EMBASE、Web of Science 和 Cochrane 图书馆数据库中搜索了包含比较胸腔内纤维蛋白溶解酶和 DNA 酶与单独使用胸腔内纤维蛋白溶解酶或 DNA 酶治疗的住院成人和儿童胸腔感染患者的观察性研究和随机对照试验（RCT）的比较数据。使用 Review Manager 软件进行荟萃分析，并使用 I 统计量检验异质性。
共有 2 个队列和 2 个 RCT 纳入了 362 名成人和儿童患者。与单独使用胸腔内纤维蛋白溶解酶或 DNA 酶相比，接受胸腔内纤维蛋白溶解酶和 DNA 酶联合治疗的患者手术干预需求显著减少（OR 0.30；95%CI 0.11-0.83；I = 31%；P = 0.02）。两组患者死亡率（OR 0.72；95%CI 0.31-1.71；I = 0%；P = 0.46）和并发症发生率（OR 3.09；95%CI 0.75-12.74；I = 54%；P = 0.12）无差异。两组患者的住院时间（平均 13.70 天比 16.67 天；P = 0.19）和胸腔引流管留置时间（平均 6.47 天比 6.30 天；P = 0.58）相似。
与单独使用胸腔内纤维蛋白溶解酶治疗相比，胸腔内纤维蛋白溶解酶和 DNA 酶联合治疗与较少的手术干预需求相关。然而，两组患者死亡率、住院时间和胸腔引流管留置时间无差异。
