Wu W, Teixeira L R, Light R W
Department of Medicine, Saint Thomas Hospital and Vanderbilt University, Nashville, Tenn 37202, USA.
Chest. 1998 Aug;114(2):563-8. doi: 10.1378/chest.114.2.563.
We have reported previously that there is a high incidence of hemothorax and substantial mortality in rabbits that are given tetracycline derivatives intrapleurally. However, such complications have not been reported in humans when pleurodesis is attempted with tetracycline derivatives. One primary difference in the two situations is that a chest tube is placed only in humans. The objective of this study was to evaluate the hypothesis that chest tube placement would prevent the development of hemothoraces and lead to better pleurodesis in rabbits given doxycycline intrapleurally. Eighty New Zealand White male rabbits received doxycycline, 20 mg/kg, in a total volume of 2 mL. One half of the rabbits were randomized to receive a chest tube at the time of the injection and were subjected to pleural fluid aspiration twice daily. The remaining rabbits (control group) received no chest tube and no aspiration. Ten rabbits from each group were killed on days 4, 7, 14, and 28. The intrapleural injection of doxycycline induced the production of large exudative effusions. The insertion of chest tubes prevented the development of hemothorax (0/20 in chest tube group, 15/20 in control group, p<0.001). The insertion of chest tubes was also associated with a significant reduction in mortality and a significant improvement in pleurodesis. When pleurodesis is attempted in rabbits with intrapleural doxycycline, the insertion of a chest tube will prevent hemothorax and lead to a better pleurodesis.
我们之前报道过，给兔子胸膜腔内注射四环素衍生物后，血胸发生率很高且死亡率可观。然而，当用四环素衍生物进行胸膜固定术时，人类中尚未报道过此类并发症。这两种情况的一个主要差异在于，仅在人类身上放置胸管。本研究的目的是评估以下假设：放置胸管可预防血胸的发生，并使胸膜腔内注射强力霉素的兔子获得更好的胸膜固定效果。80只新西兰白兔接受了总量为2 mL、剂量为20 mg/kg的强力霉素。一半兔子在注射时随机接受胸管置入，并每天进行两次胸腔积液抽吸。其余兔子（对照组）未接受胸管置入也未进行抽吸。每组各10只兔子在第4天、第7天、第14天和第28天处死。胸膜腔内注射强力霉素诱导产生大量渗出性胸腔积液。胸管置入可预防血胸的发生（胸管组0/20，对照组15/20，p<0.001）。胸管置入还与死亡率显著降低及胸膜固定效果显著改善相关。当对兔子进行胸膜腔内强力霉素胸膜固定术时，置入胸管可预防血胸并带来更好的胸膜固定效果。
