Mixing It Up Coadministration of tPA/DNase in Complicated Parapneumonic Pleural Effusions and Empyema
Mixing It Up Coadministration of tPA/DNase in Complicated Parapneumonic Pleural Effusions and Empyema
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DOI：
10.1097/lbr.0000000000000334
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发表时间：
2017-01-01
影响因子：
3.3
通讯作者：
Nishi, Shawn P. E.
中科院分区：
文献类型：
--
作者：
Bishwakarma, Raju;Shah, Shiwan;Nishi, Shawn P. E.
背景资料：最近的一项随机对照试验显示，12个系列剂量的组织型纤溶酶原激活剂（tPA）和脱氧核糖核酸酶（DNase）治疗复杂性胸膜旁胸腔积液和脓胸（CPEE）是安全有效的。然而，该方案是费力的，需要受过训练的人员每天打开/关闭胸管8次，持续3天。我们提出我们的观察数据使用一个简化的方案，共同管理tPA/DNase.Materials和Methods：这是一个回顾性观察研究的患者接受共同管理tPA/DNase CPEE从2012年1月至2015年4月在得克萨斯大学医学分支。收集患者的人口统计学资料、胸腔积液、放射学和治疗特征以及结局。数据以比例和百分比表示。我们的主要结果是成功治疗，无需手术，出院回家活着。次要结果是剂量和治疗时间、住院时间、治疗并发症和90天死亡率。所有胸腔积液呈分叶状，59%肉眼可见脓性，50%革兰氏染色阳性，40%培养阳性。主要通过小口径胸管联合给药的中位剂量为6（四分位数范围，3.5至6）（
Background: A recent randomized controlled trial showed 12 serial doses of tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) is safe and effective in managing complicated parapneumonic pleural effusions and empyema (CPEE). However, this regimen is laborious, requiring trained personnel to open/close the chest tube 8 times daily for 3 days. We present our observational data using a simplified regimen of coadministered tPA/DNase.Materials and Methods: This is a retrospective observational study of patients who received coadministered tPA/DNase for CPEE from January 2012 to April 2015 at the University of Texas Medical Branch. Patient demographics, pleural fluid, radiologic and treatment characteristics, and outcomes were collected. Data are presented as proportions and percentages. Our primary outcome was successful treatment without need of surgery and discharge home alive. Secondary outcomes were dose and length of treatment and hospital stay, treatment complications, and 90-day mortality.Results: The study included 39 patients. All pleural effusions were loculated, 59% macroscopically purulent, 50% had a positive organism in Gram stain, and 40% were culture positive. A median of 6 (interquartile range, 3.5 to 6) doses were coadministered mainly via small bore chest tube (