Intrapleural Urokinase Treatment in Children with Complicated Parapneumonic Effusion

肋膜間尿素激酶治療兒童複雜性肺炎併發肋膜積水

陳榮賓(Jung-Pin Chen) ； 呂克桓(Ko-Huang Lue) ； 劉淑智(Shu-Chih Liu) ； 鄭森隆(Sun-Long Cheng) ； 許績男(Ji-Nan Sheu)

《Acta Paediatrica Taiwanica》 47卷2期 (2006/04) Pp. 61-66

https://doi.org/10.7097/APT.200604.0061

摘要

Intrapleural instillation of fibrinolytic agent such as urokinase has been shown to be effective as an adjunctive therapy for children with complicated parapneumonic effusion and empyema. In this study, we described our experience with the use of intrapleural urokinase in the management of complicated parapneumonic effusion in children. We collected 13 patients with a mean age of 50.8 months with parapneumonic pleural effusion or empyema; all were treated with intrapleural urokinase after poor response to appropriate antibiotics and simple tube drainage. We also reviewed another 13 patients with a mean age of 45.8 months from the clinical records of children hospitalized with the same conditions prior to urokinase introduction as a control group. The mean fluid drained during the first 24 hours and the first 72 hours after urokinase instillation were significantly greater than those during 24 hours before instillation, p=0.002 and p＜0.001, respectively. The total volume of fluid drained was also greater in the urokinase group than that in the control group (p=0.001). The mean duration of chest tube drainage was significantly shorter in the urokinase group (8.7±2.8 days vs. 14.7±6.1 days, p＜0.02). The mean length of hospitalization was also significantly shorter in the urokinase group (15.5±5.3 days vs. 24.4±6.9 days, p=0.002). All 13 patients were managed successfully with urokinase treatment without further surgical procedures. None of the patients experienced any side effect or adverse event after urokinase instillation. Two patients of the control group finally underwent surgical debridement. In conclusion, the use of intrapleural urokinase treatment in children with complicated parapneumonic effusion is an effective and safe therapy.

關鍵字

尿素激酶 ； 肺炎併發複雜性肋膜積水 ； 膿胸 ； 兒童

並列摘要

Intrapleural instillation of fibrinolytic agent such as urokinase has been shown to be effective as an adjunctive therapy for children with complicated parapneumonic effusion and empyema. In this study, we described our experience with the use of intrapleural urokinase in the management of complicated parapneumonic effusion in children. We collected 13 patients with a mean age of 50.8 months with parapneumonic pleural effusion or empyema; all were treated with intrapleural urokinase after poor response to appropriate antibiotics and simple tube drainage. We also reviewed another 13 patients with a mean age of 45.8 months from the clinical records of children hospitalized with the same conditions prior to urokinase introduction as a control group. The mean fluid drained during the first 24 hours and the first 72 hours after urokinase instillation were significantly greater than those during 24 hours before instillation, p=0.002 and p＜0.001, respectively. The total volume of fluid drained was also greater in the urokinase group than that in the control group (p=0.001). The mean duration of chest tube drainage was significantly shorter in the urokinase group (8.7±2.8 days vs. 14.7±6.1 days, p＜0.02). The mean length of hospitalization was also significantly shorter in the urokinase group (15.5±5.3 days vs. 24.4±6.9 days, p=0.002). All 13 patients were managed successfully with urokinase treatment without further surgical procedures. None of the patients experienced any side effect or adverse event after urokinase instillation. Two patients of the control group finally underwent surgical debridement. In conclusion, the use of intrapleural urokinase treatment in children with complicated parapneumonic effusion is an effective and safe therapy.

並列關鍵字

urokinase ； complicated parapneumonic effusion ； empyema ； children