Roupie E, Bouabdallah K, Delclaux C, Brun-Buisson C, Lemaire F, Vasile N, Brochard L
Department of Intensive Care Unit, INSERM U 296, Paris XII University, Hôpital Henri Mondor, Créteil, France.
Intensive Care Med. 1996 Dec;22(12):1351-3. doi: 10.1007/BF01709550.
To determine the usefulness and the results of a strategy using intrapleural streptokinase (SK) instillation guided by repeated computed tomography (CT) scan examinations in pleural empyemas unresponsive to chest tube drainage.
A retrospective chart review.
The medical Intensive Care Unit and Department of Radiology, in a university hospital.
Sixteen patients with empyema who had a persistent pleural effusion despite drainage, among 37 patients with infectious pleural effusion.
In the 16 patients, CT examination was performed before and at least once after SK. Intrapleural SK was instilled, either through the chest tube or via a needle puncture, according to the CT scan results.
The first CT scan confirmed a persistent effusion in all, showing a multiloculated effusion in 13 patients, and an ectopic loculus in one. The first SK instillation resulted in a dramatic increase of fluid drained per day (from 68 +/- 28 ml to 567 +/- 262 ml; p < 0.001), leading to complete resolution in 11 patients, while the others required a second CT scan-guided procedure. In one, the chest tube was misplaced, while in two, transparietal injection was needed. Finally, a complete resolution was observed in 14 (87.5%) of the patients. Two patients had a poor initial response to SK and were eventually scheduled for video-thoracoscopy. A single episode of chills and fever was observed among 32 SK instillations.
CT-guided SK instillation in pleural empyema appears to be safe, and allowed complete resolution in 87.5% of our patients.
确定在胸腔闭式引流效果不佳的脓胸患者中，采用重复计算机断层扫描（CT）检查引导下胸腔内注入链激酶（SK）策略的有效性及结果。
回顾性病历分析。
一所大学医院的内科重症监护病房及放射科。
37例感染性胸腔积液患者中，16例尽管已行引流但仍存在持续性胸腔积液的脓胸患者。
16例患者在注入SK前及至少一次注入后进行CT检查。根据CT扫描结果，通过胸腔闭式引流管或经皮穿刺注入胸腔内SK。
首次CT扫描证实所有患者均存在持续性积液，其中13例为多房性积液，1例为异位腔隙。首次注入SK后每日引流量显著增加（从68±28ml增至567±262ml；p<0.001），11例患者积液完全消退，其余患者需再次行CT引导下操作。1例患者胸腔闭式引流管位置不当，2例患者需经胸壁注射。最终，14例（87.5%）患者积液完全消退。2例患者对SK初始反应不佳，最终安排行电视胸腔镜检查。32次SK注入过程中观察到1次寒战和发热。
CT引导下胸腔内注入SK治疗脓胸似乎是安全的，87.5%的患者积液完全消退。
