Bhagat Milind, Adusumilli Ajay Krishan, Ghimire Ananta, Cho Roy Joseph
Department of Pulmonary, Allergy, Critical Care and Sleep Division, University of Minnesota, Minneapolis, MN, USA.
CoGuide Academy, Bangalore, India.
J Thorac Dis. 2024 Oct 31;16(10):7155-7164. doi: 10.21037/jtd-24-832. Epub 2024 Oct 30.
The presence of free air in the pleural space of lungs is termed pneumothorax and in individuals with underlying lung disease, it is known as secondary spontaneous pneumothorax. The incidence of spontaneous pneumothorax is 16 to 18 per lakh population. The most common causes for secondary spontaneous pneumothorax are chronic obstructive pulmonary disease (COPD), tuberculosis (TB), human immunodeficiency virus (HIV), cystic fibrosis of lung, and history of smoking. The clinical signs and symptoms include acute dyspnea, thoracic pain and cough. Persistent air leaks are frequently seen in secondary spontaneous pneumothorax. The incidence of persistent air leaks in post-surgical patients varies from 8% to 43%. The aim of the study is to compare the efficacy of doxycycline, tetracycline, and minocycline to other pleurodesis agents in the cessation of air leaks and reducing the recurrence of pneumothorax in adults with persistent air leaks following secondary spontaneous pneumothorax.
A systematic search from PubMed, Cochrane, Embase, Web of Science, and clinical trials.gov was performed. After screening, three studies were selected which includes 2 randomized controlled trials (RCTs) and 1 prospective study with a pooled sample size of 168.
The mean age and standard deviation of the study participants was 50.57±13.23 years. The success rate of autologous blood patch pleurodesis (ABPP) was reported as 94.70% followed by doxycycline with 84.20%, talc with 84% and tetracycline 63%. The mean time of cessation of air leaks was lowest with doxycycline (11 and 36 hours) and ABPP (24 and 27 hours). Furthermore, ABPP is reported having fewer complications when compared with other agents.
Among chemical pleurodesis agents, doxycycline is reported to be having higher success rate and less recurrences. However, it is found to be inferior when compared directly to ABPP.
肺胸膜腔内出现游离气体称为气胸，在患有基础肺部疾病的个体中，则称为继发性自发性气胸。自发性气胸的发病率为每10万人中有16至18例。继发性自发性气胸最常见的病因是慢性阻塞性肺疾病（COPD）、肺结核（TB）、人类免疫缺陷病毒（HIV）、肺囊性纤维化以及吸烟史。临床体征和症状包括急性呼吸困难、胸痛和咳嗽。继发性自发性气胸患者经常出现持续性漏气。术后患者持续性漏气的发生率在8%至43%之间。本研究的目的是比较多西环素、四环素和米诺环素与其他胸膜固定术药物在继发性自发性气胸后持续性漏气的成人患者中停止漏气和降低气胸复发率方面的疗效。
对PubMed、Cochrane、Embase、科学网和临床试验.gov进行了系统检索。筛选后，选择了三项研究，其中包括两项随机对照试验（RCT）和一项前瞻性研究，汇总样本量为168。
研究参与者的平均年龄和标准差为50.57±13.23岁。自体血贴片胸膜固定术（ABPP）的成功率报告为94.70%，其次是多西环素，为84.20%，滑石粉为84%，四环素为63%。多西环素（11和36小时）和ABPP（24和27小时）的漏气停止平均时间最短。此外，与其他药物相比，ABPP的并发症较少。
在化学性胸膜固定术药物中，多西环素的成功率较高且复发率较低。然而，与ABPP直接比较时，发现其效果较差。
