Chin N K, Lim T K
Department of Medicine, National University Hospital, Singapore.
Chest. 1997 Feb;111(2):275-9. doi: 10.1378/chest.111.2.275.
To compare the efficacy of adjunctive intrapleural streptokinase (SK) with simple closed chest tube drainage (Drain) in the treatment of empyemas and complicated parapneumonic effusions.
This was a controlled study of 52 patients (mean age, 57 years; 41 men) with pleura space sepsis. Forty patients (77%) had empyema and 12 had complicated parapneumonic effusions. Twenty-nine patients were treated with Drain only while 23 received, in addition, repeated daily SK, 250,000 U in saline solution (mean, 5.3 days).
The two groups of patients had comparable degrees of peripheral blood leukocytosis, frequency of loculated effusions, pleural fluid pH, and lactate dehydrogenase levels. Infective organisms were isolated in 54% of which 32% were anaerobic and 21% were polymicrobial infections. The incidence of surgical decortication was 17% and mortality was 15%. A significantly larger volume of pleural fluid was drained from patients in the SK treatment group (2.0 [1.5] L) than those in the Drain treatment group (1.0 [1.01] L). There were no significant differences, however, between the two treatment groups in terms of duration before defervescence, duration of hospital stay, the need for surgical intervention, or mortality rates.
We conclude that thrombolytic therapy increased the volume of fluid drained from pleural empyemas but did not markedly reduce morbidity and mortality.
比较胸膜腔内注射链激酶（SK）辅助治疗与单纯胸腔闭式引流（引流组）治疗脓胸及复杂性肺炎旁胸腔积液的疗效。
这是一项针对52例胸膜腔感染患者（平均年龄57岁，男性41例）的对照研究。40例（77%）为脓胸患者，12例为复杂性肺炎旁胸腔积液患者。29例患者仅接受引流治疗，23例患者除引流外还每日重复注射SK，剂量为25万单位，溶于盐溶液中（平均5.3天）。
两组患者的外周血白细胞增多程度、包裹性胸腔积液发生率、胸腔积液pH值及乳酸脱氢酶水平相当。54%的患者分离出感染病原体，其中32%为厌氧菌感染，21%为混合菌感染。手术剥脱术的发生率为17%，死亡率为15%。SK治疗组患者胸腔引流量（2.0[1.5]L）显著多于引流治疗组（1.0[1.01]L）。然而，两组在退热前持续时间、住院时间、手术干预需求或死亡率方面无显著差异。
我们得出结论，溶栓治疗增加了脓胸胸腔引流量，但并未显著降低发病率和死亡率。
