Koldsland S, Svennevig J L, Lehne G, Johnson E
Department of Cardiothoracic Surgery, University of Oslo, Ullevaal Hospital, Norway.
Thorax. 1993 Aug;48(8):790-3. doi: 10.1136/thx.48.8.790.
The treatment of recurrent pleural effusion in advanced malignant disease should be efficient and with tolerable side effects. Since 1983 intrathoracic instillation of the anti-malaria drug mepacrine has been used to achieve pleurodesis. The cytotoxic drug bleomycin has been claimed to be equally effective and with fewer side effects. The present study was designed to compare these two agents.
Forty patients with carcinoma and pleural effusions refractory to repeated pleural aspirations over the previous 12 weeks were randomised to receive treatment with intrathoracic instillation of mepacrine or bleomycin. Fluid volumes before and after pleurodesis, drainage time, and side effects were registered and analysed, and the response to treatment was evaluated by clinical examination and chest radiography.
The amount of fluid produced after treatment in the patients receiving mepacrine was lower than in those receiving bleomycin, and the duration of chest drainage was shorter. After 30 days 16 of 20 in the mepacrine group responded to treatment and 10 of 20 in the bleomycin group. Most patients died during the three months observation period. Moderate side effects occurred equally in both groups.
Chemical pleurodesis can reduce or stop pleural effusion in many patients, and in this study mepacrine appeared to be more efficient than bleomycin. A prospective study with a larger number of patients is now warranted.
晚期恶性疾病复发性胸腔积液的治疗应有效且副作用可耐受。自1983年以来，抗疟疾药物米帕林胸腔内注射已被用于实现胸膜固定术。细胞毒性药物博来霉素据称同样有效且副作用较少。本研究旨在比较这两种药物。
40例在过去12周内反复胸腔穿刺抽液后仍有胸腔积液的癌症患者被随机分为两组，分别接受米帕林或博来霉素胸腔内注射治疗。记录并分析胸膜固定术前、后的液体量、引流时间及副作用，并通过临床检查和胸部X线摄影评估治疗反应。
接受米帕林治疗的患者治疗后产生的液体量低于接受博来霉素治疗的患者，胸腔引流持续时间更短。30天后，米帕林组20例中有16例对治疗有反应，博来霉素组20例中有10例。大多数患者在三个月的观察期内死亡。两组中出现中度副作用的情况相同。
化学性胸膜固定术可使许多患者的胸腔积液减少或停止，在本研究中米帕林似乎比博来霉素更有效。现在有必要进行一项有更多患者参与的前瞻性研究。
