Intra-pleural fibrinolytic therapy in parapneumonic effusions..

Parapneumonic effusion或稱為empysema.. 通常與bacterial pneumonia, lung abscess, bronchiectasis有關.. 若病患有pneumonia合併pleural effusion..有chest pai...


Parapneumonic effusion或稱為empysema..

通常與bacterial pneumonia, lung abscess, bronchiectasis有關..

若病患有pneumonia合併pleural effusion..有chest pain, sputum production, 與leukocytosis..就要注意有沒有這樣的情況..

在chest CT或是lateral chest X-ray上出現free pleural fluid..當超過10 mm時..應該進行thoracentesis..

診斷化驗標準包括:

- pleural pH <7.20
- pleural fluid glucose <60 mg/dl
- positive Gram stain or culture of pleural fluid
- gross pus in tje pleural space

除了送他一支chest tube之外..也可以使用fibrinolytics..例如streptokinase或是urokinase

根據Cochrane Library裡面一篇update到2004年的systematic review..

比較fibrinolytics與normal saline..發現不論是streptokinase或是urokinase都可以顯著地減少hospital stay, 退燒所需的時間, 以及chest X-ray上面改善的情形..

Adapted form
Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD002312. DOI: 10.1002/14651858.CD002312.pub2.

使用的方法為:

streptokinase 250,000 U/day

urokinase 100,000 U/day

從chest tube或是pig-tail打入..又學到新東西了..

Adapted from Chest 2000; 118:1158-71.

You Might Also Like

1 comments