Abstract：
BACKGROUND: Intrapleural fibrinolytic instillation is second-line treatment for retained hemothorax. Dornase alfa (DNase) has demonstrated efficacy in parapneumonic effusion, but the lack of deoxyribonucleoproteins limits direct extrapolation to traumatic retained hemothorax treatment.
OBJECTIVE: This study evaluated the effectiveness of intrapleural tissue plasminogen activator (tPA) with and without DNase in the treatment of retained traumatic hemothorax.
METHODS: This retrospective cohort study included patients aged 16 years and older admitted to a level 1 trauma center from January 2013 through July 2019 with retained hemothorax and one or more intrapleural tPA instillations. Exclusion criteria were tPA for other indications or concomitant empyema. The primary endpoint was treatment failure defined as the need for operative intervention.
RESULTS: Fifty patients were included (tPA alone: 28; tPA with DNase: 22). Baseline characteristics were similar between groups, including time to diagnosis (6.5 [interquartile range (IQR), 4-15.5] days vs 6 [IQR, 6.3-10.8] days, P = 0.52). Median tPA dose per treatment (6 [IQR, 6-6.4] mg vs 10 [IQR, 8.4-10] mg, P < 0.001) and cumulative tPA (18 [IQR, 6.5-24] mg vs 30 [IQR, 29.5-40], P < 0.001) dose were significantly lower in the tPA alone group. Treatment failure was similar between groups. Chest tube output, retained hemothorax reduction, and bleeding incidences were similar between groups. Multivariate logistic regression demonstrated no significant risk factors for treatment failure.
CONCLUSIONS: Dornase alfa added to tPA may not reduce the need for operation to treat retained hemothorax. Further studies should be directed at optimal tPA dose determination and economic impact of inappropriate DNase use.
OBJECTIVE: This study evaluated the effectiveness of intrapleural tissue plasminogen activator (tPA) with and without DNase in the treatment of retained traumatic hemothorax.
METHODS: This retrospective cohort study included patients aged 16 years and older admitted to a level 1 trauma center from January 2013 through July 2019 with retained hemothorax and one or more intrapleural tPA instillations. Exclusion criteria were tPA for other indications or concomitant empyema. The primary endpoint was treatment failure defined as the need for operative intervention.
RESULTS: Fifty patients were included (tPA alone: 28; tPA with DNase: 22). Baseline characteristics were similar between groups, including time to diagnosis (6.5 [interquartile range (IQR), 4-15.5] days vs 6 [IQR, 6.3-10.8] days, P = 0.52). Median tPA dose per treatment (6 [IQR, 6-6.4] mg vs 10 [IQR, 8.4-10] mg, P < 0.001) and cumulative tPA (18 [IQR, 6.5-24] mg vs 30 [IQR, 29.5-40], P < 0.001) dose were significantly lower in the tPA alone group. Treatment failure was similar between groups. Chest tube output, retained hemothorax reduction, and bleeding incidences were similar between groups. Multivariate logistic regression demonstrated no significant risk factors for treatment failure.
CONCLUSIONS: Dornase alfa added to tPA may not reduce the need for operation to treat retained hemothorax. Further studies should be directed at optimal tPA dose determination and economic impact of inappropriate DNase use.
摘要：
背景：胸膜内纤溶滴注是保留血胸的二线治疗方法。Dornasealfa（DNase）已证明在肺炎旁积液中的疗效，但是脱氧核糖核蛋白的缺乏限制了对创伤性保留血胸治疗的直接外推。
目的：本研究评估了胸膜内组织型纤溶酶原激活剂（tPA）加或不加DNase治疗保留的创伤性血胸的有效性。
方法：这项回顾性队列研究纳入了2013年1月至2019年7月入住1级创伤中心的16岁及以上患者，并保留血胸和一次或多次胸膜内滴注tPA。排除标准为其他适应症或合并脓胸的tPA。主要终点是治疗失败，定义为需要手术干预。
结果：纳入50例患者（单独tPA：28；含DNA酶的tPA：22）。组间基线特征相似，包括诊断时间(6.5[四分位数间距(IQR)，4-15.5]天vs6[IQR，6.3-10.8]天，P=0.52）。每次治疗的中位tPA剂量(6[IQR，6-6.4]毫克vs10[IQR，8.4-10]mg,P<0.001)和累积tPA(18[IQR，6.5-24]mgvs.30[IQR，29.5-40],P<0.001)剂量在单独tPA组中显著降低。两组治疗失败情况相似。胸管输出,保留血胸减少，两组间出血发生率相似.多因素logistic回归分析显示治疗失败无显著危险因素。
结论：在tPA中添加Dornasealfa可能不会减少手术治疗保留血胸的需要。进一步的研究应针对最佳的tPA剂量确定和不适当的DNase使用的经济影响。
目的：本研究评估了胸膜内组织型纤溶酶原激活剂（tPA）加或不加DNase治疗保留的创伤性血胸的有效性。
方法：这项回顾性队列研究纳入了2013年1月至2019年7月入住1级创伤中心的16岁及以上患者，并保留血胸和一次或多次胸膜内滴注tPA。排除标准为其他适应症或合并脓胸的tPA。主要终点是治疗失败，定义为需要手术干预。
结果：纳入50例患者（单独tPA：28；含DNA酶的tPA：22）。组间基线特征相似，包括诊断时间(6.5[四分位数间距(IQR)，4-15.5]天vs6[IQR，6.3-10.8]天，P=0.52）。每次治疗的中位tPA剂量(6[IQR，6-6.4]毫克vs10[IQR，8.4-10]mg,P<0.001)和累积tPA(18[IQR，6.5-24]mgvs.30[IQR，29.5-40],P<0.001)剂量在单独tPA组中显著降低。两组治疗失败情况相似。胸管输出,保留血胸减少，两组间出血发生率相似.多因素logistic回归分析显示治疗失败无显著危险因素。
结论：在tPA中添加Dornasealfa可能不会减少手术治疗保留血胸的需要。进一步的研究应针对最佳的tPA剂量确定和不适当的DNase使用的经济影响。
