目的:在复杂的肺炎旁积液或脓胸中,大约25%的患者需要手术干预,这可能导致近20%的死亡风险.然而,rt-tPA和DNase在手术风险过高的老年患者中的联合使用改善了结局.我们研究的主要目标是强调胸膜腔内溶栓在手术风险过高的患者中的实用性。
方法:对2015年1月1日至3月18日用tPA和DNase治疗的复杂肺炎旁胸腔积液或脓胸患者(n=23)进行回顾性记录回顾研究,2019年在VACHCS。收集的描述胸膜内溶栓治疗结果的数据包括人口统计,胸腔积液分析,手术风险评估,诊断和开始治疗日,剂量,胸部成像,排水率,胸管大小和平均到位天数,炎症标志物,微生物学,抗生素,和并发症。
结果:只有21.7%的患者被认为是手术候选人。使用国家外科办公室(NSO)风险计算器,74%的患者术后30天死亡风险>2.5%。术后住院率为99.7%,术后ICU平均住院率为>80%。主要结果(胸膜引流改善)为73.9%。最常见的严重并发症包括脓毒症(52.2%),非严重并发症为残余液气胸(47.8%)。
结论:这项研究表明,在选定的高龄人群中,通过经皮胸膜导管进行胸膜腔内溶栓治疗可安全地成功引流,无需手术干预。被认为是高手术风险的胸膜感染的老年患者。
In complicated parapneumonic effusion or Empyema, approximately 25% of patients require surgical intervention which can be associated with a mortality risk of almost 20%. However, the use combination of rt-tPA and DNase in elderly patients with prohibitive surgical risk has improved outcomes. The main goal of our study is to highlight the utility of intrapleural thrombolysis in patients with prohibitive risk for surgery.
A retrospective record review study of patients (n=23) with complicated parapneumonic pleural effusion or empyema treated with tPA and DNase from January 1st of 2015 to March 18th, 2019 at VACHCS. Data collected to describe the outcome of intrapleural thrombolytics included demographic, pleural fluid analysis, surgical risk assessment, diagnosis and initiation treatment day, doses, chest imaging, drainage rate, chest tube size and average days in place, inflammatory markers, microbiology, antibiotics, and complications.
Only 21.7% of patients were considered surgical candidates. Seventy-four percent had a 30-day post-surgical mortality risk of > 2.5% using the National Surgery Office (NSO) risk calculator. Post-operative inpatient stay was 99.7% and estimated post operative ICU stay average was >80%. Primary outcome (pleural drainage improvement) obtained in 73.9%. Most common serious complications included sepsis (52.2%) and nonserious was residual hydropneumothorax (47.8%).
This study demonstrates that administration of intrapleural thrombolytics through a percutaneous pleural catheter achieved successful drainage safely and without the need for surgical interventions in a selected group of advanced age, elderly patients with pleural infections who were deemed to be high surgical risk.