Bouros D, Schiza S, Tzanakis N, Chalkiadakis G, Drositis J, Siafakas N
Departments of Thoracic Medicine, Thoracic Surgery, and Clinical Pharmacology, Medical School, University of Crete, and University General Hospital, Heraklion, Crete, Greece.
Am J Respir Crit Care Med. 1999 Jan;159(1):37-42. doi: 10.1164/ajrccm.159.1.9803094.
Intrapleural administration of fibrinolytic agents has been shown to be effective and safe in the treatment of loculated parapneumonic pleural effusions. However, controlled studies of the possible role of the activity of urokinase (UK) through the volume effect are lacking. We therefore investigated the hypothesis that UK is effective through the lysis of pleural adhesions and not through the volume effect. Thirty-one consecutive patients with multiloculated pleural effusions were randomly assigned to receive either intrapleural UK (15 patients) or normal saline (NS) (16 patients) for 3 d, in a double-blind manner. All patients had inadequate drainage through a chest tube (< 70 ml/24 h). UK was given daily through the chest tube in a dose of 100.000 IU diluted in 100 ml of NS. Controls were given the same volume of NS intrapleurally. Response was assessed by clinical outcome, fluid drainage, chest radiography, pleural ultrasonography (US) and/or computed tomography (CT). Clinical and radiographic improvement was noted in all but two patients in the UK group but in only four in the control group. The net mean volume drained during the 3-d treatment period was significantly greater in the UK group (970 +/- 75 ml versus 280 +/- 55 ml, p < 0.001). Pleural fluid drainage was complete in 13 (86.5%) patients in the UK group (two patients were treated through video-assisted thoracoscopy) but in only four (25%) in the control group. Twelve patients in the control group were subsequently treated with UK and six of them had complete drainage; the remaining six patients had complete drainage after video-assisted thoracoscopy. Our results suggest that UK is effective in the treatment of loculated pleural effusions through the lysis of pleural adhesions and not through the volume effect.
胸腔内注射纤维蛋白溶解剂已被证明在治疗局限性类肺炎性胸腔积液中是有效且安全的。然而，关于尿激酶（UK）活性通过容量效应可能发挥的作用，缺乏对照研究。因此，我们研究了这样一个假设，即UK通过溶解胸膜粘连发挥作用，而非通过容量效应。31例连续性多房性胸腔积液患者被随机双盲分配，接受胸腔内UK治疗（15例）或生理盐水（NS）治疗（16例），为期3天。所有患者经胸腔引流管引流不畅（<70 ml/24 h）。UK通过胸腔引流管每日给药，剂量为100,000 IU，用100 ml NS稀释。对照组胸腔内给予相同体积的NS。通过临床结果、液体引流量、胸部X线摄影、胸膜超声（US）和/或计算机断层扫描（CT）评估反应。UK组除2例患者外，所有患者临床和影像学均有改善，而对照组仅4例有改善。UK组在3天治疗期内的平均净引流量显著高于对照组（970±75 ml对280±55 ml，p<0.001）。UK组13例（86.5%）患者胸腔积液引流完全（2例患者通过电视辅助胸腔镜治疗），而对照组仅4例（25%）引流完全。对照组12例患者随后接受UK治疗，其中6例完全引流；其余6例患者在电视辅助胸腔镜检查后完全引流。我们的结果表明，UK通过溶解胸膜粘连而非通过容量效应治疗局限性胸腔积液有效。
