滑石粉胸膜固定术后脓胸的相关危险因素。

Risk factors related to pleural empyema after talc slurry pleurodesis.

机构信息

Instituto do Câncer do Estado de São Paulo (ICESP), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.

出版信息

Clinics (Sao Paulo). 2022 Aug 27;77:100098. doi: 10.1016/j.clinsp.2022.100098. eCollection 2022.

DOI:10.1016/j.clinsp.2022.100098

PMID:36041370

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9440271/

Abstract

OBJECTIVE

Empyema is a complication of talc-pleurodesis that may lead to further surgical intervention and death. Therefore, the present study's objective was to identify the risk factors for the development of post-pleurodesis empyema after talc slurry pleurodesis in order to better select patients for this procedure and minimize its morbidity.

METHODS

Patients with malignant pleural effusion who underwent talc slurry pleurodesis at the present institution from January 2018 to January 2020 were retrospectively analyzed. Post-pleurodesis empyema was defined as pleural infection up to 30 days after pleurodesis. Using Cox regression analysis, significant prognostic factors for the development of empyema were examined.

RESULTS

Of the 86 patients identified for inclusion in the study, 62 were women (72%). Their mean age was 56.3±12.6 years. The median pleural drainage time was 9 days, and 20 patients (23.3%) developed empyema. In the univariate analysis, both drainage time (p = 0.038) and the use of antibiotics prior to pleurodesis (p < 0.001) were risk factors for pleural empyema. Multivariate analysis also identified the use of antibiotics as an independent risk factor (Odds Ratio [OR] 9.81; 95% Confidence Interval [95% CI] 2.87‒33.54). Although the pulmonary expansion was not associated with empyema in the multivariate analysis, patients with less than 50% pulmonary expansion had a 4.5-times increased risk of empyema (95% CI 0.90‒22.86; p = 0.067), and patients with 50‒70% pulmonary expansion had a 3.8-times increased risk of empyema (95% CI 0.98‒15; p = 0.053) after pleurodesis.

CONCLUSION

The study suggests that antibiotic therapy prior to talc slurry pleurodesis may increase the risk of developing empyema. Furthermore, pleurodesis should be considered with caution in patients with long-duration chest tube placement and incomplete lung expansion.

摘要

目的

脓胸是滑石粉胸膜固定术的一种并发症，可能导致进一步的手术干预和死亡。因此，本研究的目的是确定滑石粉浆胸膜固定术后发生胸膜固定术后脓胸的危险因素，以便更好地选择接受该手术的患者，并将其发病率降至最低。

方法

回顾性分析了 2018 年 1 月至 2020 年 1 月在本机构接受滑石粉浆胸膜固定术的恶性胸腔积液患者。术后 30 天内发生的脓胸定义为胸膜感染。采用 Cox 回归分析，探讨发生脓胸的显著预后因素。

结果

本研究共纳入 86 例患者，其中 62 例为女性（72%）。患者的平均年龄为 56.3±12.6 岁。中位胸腔引流时间为 9 天，20 例（23.3%）发生脓胸。单因素分析显示，引流时间（p=0.038）和胸膜固定术前使用抗生素（p<0.001）均为发生脓胸的危险因素。多因素分析也发现使用抗生素是一个独立的危险因素（优势比[OR]9.81；95%置信区间[95%CI]2.87-33.54）。尽管在多因素分析中肺扩张程度与脓胸无关，但肺扩张小于 50%的患者发生脓胸的风险增加 4.5 倍（95%CI 0.90-22.86；p=0.067），肺扩张 50%-70%的患者发生脓胸的风险增加 3.8 倍（95%CI 0.98-15；p=0.053）。