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Abstract：
Our study aimed to assess the benefit of intrapleural fibrinolysis before resorting to surgery to treat complicated parapneumonic effusion and empyema. We conducted a retrospective and descriptive study, including all patients hospitalized in the intensive care unit (ICU) of the Abderhaman Mami hospital, Tunisia for empyema treated with instillation of intrapleural fibrinolytic therapy between the 1st January 2000 and 31st December 2016. In all patients, empyema was diagnosed on clinical features, imaging findings (chest X-ray, thoracic echography and/or computed tomography (CT), and microbiological data. The fibrinolytic agent used was streptokinase. The efficiency of intrapleural fibrinolytic therapy was judged on clinical and paraclinical results. Among 103 cases of complicated parapneumonic effusion and empyema, 34 patients were included. The mean age was 34 years [15-81] with a male predominance (sex ratio at 2.77). Median APACH II score was 9. Fifty (50%) of the patients (n=17) had no past medical history; addictive behavior was described in 17 patients (50%). All patients were admitted for acute respiratory failure and one patient for septic shock. Pleural effusion was bilateral in 7 patients. Bacteria isolated were Streptococcus pneumonia (6 cases), Staphylococcus aureus (3 cases, including one which methicillin-resistant), Staphylococcus epidermidis (1 case), anaerobes (5 cases), and Klebsiella pneumoniae (1 case). First-line antimicrobial drug therapy was amoxicillin-clavulanate in 20 patients. A chest drain was placed in all cases in the first 38 hours of ICU admission. The median number of fibrinolysis sessions was 4 [2-9] and the median term of drainage was 7 days [3-16]. No side effects were observed. Video-assisted thoracoscopic surgery was proposed in 5 patients. The median length of hospitalization stay was 15 days [6-31]. One patient died due to multi-organ failure.
摘要：
我们的研究旨在评估在采用手术治疗复杂的肺炎旁积液和脓胸之前胸膜内纤溶的益处。我们进行了一项回顾性和描述性研究，包括在AbderhamanMami医院重症监护病房（ICU）住院的所有患者，突尼斯治疗脓胸，在2000年1月1日至2016年12月31日期间滴注胸膜内纤溶疗法。在所有患者中，脓胸是根据临床特征诊断的，影像学发现(胸部X线，胸部回波描记术和/或计算机断层扫描（CT），和微生物数据。使用的纤维蛋白溶解剂是链激酶。根据临床和临床结果判断胸膜内纤溶治疗的效率。在103例复杂的肺炎旁积液和脓胸中，包括34例患者。平均年龄为34岁[15-81]，男性占主导地位（性别比为2.77）。APACHⅡ评分中位数为9。50（50％）的患者（n=17）没有既往病史；在17例患者（50％）中描述了成瘾行为。所有患者均因急性呼吸衰竭入院，1例患者因感染性休克入院。7例患者双侧胸腔积液。分离的细菌为肺炎链球菌（6例），金黄色葡萄球菌（3例，包括耐甲氧西林的)，表皮葡萄球菌(1例),厌氧菌（5例），肺炎克雷伯菌(1例)。20例患者的一线抗菌药物治疗为阿莫西林-克拉维酸。在入住ICU的前38小时内，所有病例都进行了胸腔引流。纤溶过程的中位数为4[2-9]，引流的中位数为7天[3-16]。没有观察到副作用。5例患者提出电视胸腔镜手术。住院时间中位数为15天[6-31]。一名患者因多器官衰竭死亡。
