Bouros D, Schiza S, Panagou P, Drositis J, Siafakas N
Department of Thoracic Medicine, University Hospital, Heraklion, Crete, Greece.
Thorax. 1994 Sep;49(9):852-5. doi: 10.1136/thx.49.9.852.
Intrapleural administration of streptokinase has been shown in a few small series to be effective treatment for complicated parapneumonic effusions and pleural empyemas, but techniques of instillation of streptokinase differ. The role of streptokinase in promoting drainage was investigated prospectively in a larger series of patients with complicated parapneumonic effusions and pleural empyemas.
Twenty consecutive patients with parapneumonic effusions, 15 with complicated parapneumonic effusions and five with pleural empyemas, drawn from 160 patients presenting with pleural effusions were studied. The age of the patients ranged from 15 to 92 years. Initial thoracocentesis showed mean (SD) values of pH 7.1 (0.15), glucose 45.9 (17.5) mg/dl, white blood cell count 12,000 (6627)/mm3. Streptokinase was administered intrapleurally in a single daily dose of 250,000 units in 100 ml normal saline via the chest tube once the drainage was < 100 ml/24 hours. Patients were treated for 3-10 (mean 6) days.
Following administration of streptokinase a clinical and radiological improvement was noted in all but one patient who died on the fourth day of hospitalisation due to widespread adenocarcinoma. Another patient with clinical but minimal radiological improvement underwent thoracotomy, but a clear pleural space with only fibrotic changes was found. The mean (SD) volume of fluid drained 24 hours before streptokinase was 42.5 (39) ml, which increased in the first 24 hours after streptokinase to 334 (130) ml. Radiological evaluation showed an excellent improvement in 14 of the 20 patients, a moderate improvement in three, and minimal improvement in the remaining three patients. One patient developed a high fever as an adverse reaction to streptokinase. All 19 patients who completed the treatment were well at follow up 6-30 months (mean 15 months) later.
Intrapleural instillation of streptokinase is an effective and safe mode of treatment for complicated parapneumonic effusions and pleural empyemas and alleviates the need for thoracotomy.
少数小规模研究系列表明，胸膜腔内注射链激酶是治疗复杂性类肺炎性胸腔积液和胸膜脓胸的有效方法，但链激酶的滴注技术有所不同。我们对更多例复杂性类肺炎性胸腔积液和胸膜脓胸患者进行了前瞻性研究，以探讨链激酶在促进引流方面的作用。
从160例胸腔积液患者中选取连续20例类肺炎性胸腔积液患者，其中15例为复杂性类肺炎性胸腔积液，5例为胸膜脓胸。患者年龄在15至92岁之间。初次胸腔穿刺显示pH值平均（标准差）为7.1（0.15），葡萄糖为45.9（17.5）mg/dl，白细胞计数为12,000（6627）/mm³。一旦引流量<100 ml/24小时，通过胸管以每日单次剂量250,000单位链激酶溶于100 ml生理盐水中进行胸膜腔内给药。患者接受治疗3至10天（平均6天）。
注射链激酶后，除1例因广泛腺癌在住院第4天死亡的患者外，所有患者均有临床和影像学改善。另1例临床症状改善但影像学改善不明显的患者接受了开胸手术，但发现胸膜腔清晰，仅有纤维化改变。链激酶注射前24小时的平均（标准差）引流量为42.5（39）ml，注射链激酶后的头24小时增加至334（130）ml。影像学评估显示，20例患者中有14例改善显著，3例中度改善，其余3例改善不明显。1例患者出现高热，为对链激酶的不良反应。所有19例完成治疗的患者在6至30个月（平均15个月）的随访中情况良好。
胸膜腔内注射链激酶是治疗复杂性类肺炎性胸腔积液和胸膜脓胸的一种有效且安全的治疗方式，可减少开胸手术的必要性。
