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題名 | Intrapleural Streptokinase for the Treatment of Childhood Empyema=經由肋膜腔給予鏈球菌激酶治療兒童肋膜膿瘍 |
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作者 | 何文佑; 陳香吟; 顏瑜萱; 楊耀舜; 練紹弘; | 書刊名 | 臺灣兒科醫學會雜誌 |
卷期 | 48:5 2007.09-10[民96.09-10] |
頁次 | 頁251-256+288 |
分類號 | 417.5351 |
關鍵詞 | 鏈球菌激酶; 肋膜腔注射; 肺炎; 膿瘍; Streptokinase; Intrapleural instillation; Pneumonia; Empyema; |
語文 | 英文(English) |
中文摘要 | 背景:患有細菌性肺炎的小朋友常因嚴軍肋膜腔積水與膿瘍的併發症,導致罹病率與死亡率升高。胸管引流是膿胸的主要治療方法,對纖維與細胞碎屑已形成小室(loculations)的膿胸,使用鏈球菌激酶Streptokinase(SK)、Urokinase(UK)或Recombinant tissue plasminogen activator(t-PA)可促進肋膜腔內積液的引流。此篇研究爲給予鏈球菌激酶Streptokinase之胸管引流與單純胸管引流治療方法的比較;治療效果不理想即進行影像輔助性胸腔鏡手術治療(VATS)。方法:本研究自1999年至2005年共21位因肺炎合併膿胸的小朋友,分爲鏈球菌激酶之胸管引流(SK組)與單純胸管(T組)引流兩組。結果:SK組給藥後明顯地引流量較大且較單獨使用胸管T組引流時間短〔8(4.5-10)days vs. 16(5.8-20.3) days, p=0.02〕;SK組投與鏈球菌激嗨平均次數爲2.6次;SK組體溫回復正常時間也較T組短〔12.5(9.5-15.5)days vs. 16(9.5-22.5)days, p=0.14〕;SK組全部不需VATS, T組則有5位胸管引流效果不佳進行了VATS治療;SK組住院日數中位數爲21.5天較T組的24.0天爲短。結論:鏈球菌激酶副作用極少,注入胸管輔助引流較單獨以胸管引流有效。臨床醫師傾向於胸管引流不理想才給予注射鏈球菌激酶或VATS輔助治療。在第一時間即進行這兩種治療的前瞻性研究仍缺乏。 |
英文摘要 | Background: Pleuritis with empyema is a serious complication of bacterial pneumonia, which often causes substantial morbidity and mortality among pediatric patients. Currently percutaneous catheter drainage is the mainstay therapy for loculated empyema. Intrapleural instillation of streptokinase, urokinase, and recombinant tissue plasminogen activator has been reported to facilitate the drainage of viscous fluid and fibrinous debris or multiple loculations from the pleural space of such patients. Methods: In this study, we compared with the treatments of pleural empyema by instillation of streptokinase through the chest tube and using the conventional chest tube drainage alone. Results: We collected 21 cases from 1999 through 2005. The results of the study showed that streptokinase (SK) group patients revealed a larger volume of drainage in the beginning days of the instillation and required fewer days of drainage than tube drainage (T) group patients [8 (4.5-10) days vs. 16 (5.8-20.3) days, p = 0.02]; that the SK group patients required average 2.6 instillations. The SK patients had a shorter febrile course than the T group [12.5 (9.5-15.5) days vs. 16 (9.5-22.5) days, p=0.14]. None of the SK patients needed additional video-assisted thoracoscopic surgery (VATS) whereas 5 patients in the T group did. The length of hospitalization in the SK group was 21.5 days and the T group patients was 24 days. Conclusions: Intrapleural instillation of streptokinase seldom caused clinical adverse effect and appears to be a safe adjunctive therapy to facilitate the drainage of empyema in pediatric patients. Further studies with better research design to compare the fibrinolytic agent instillation and the VATS as the first step treatment of childhood empyema are needed. |
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