胸膜腔内注入纤溶剂治疗儿童脓胸的系统评价  

Systematic review of intrapleural fibrinolytic agents in treatment of childhood empyema

作　　者：窦文杰[1] 张建江[1] 史佩佩[1] 王娜[1] 曾慧勤[1] 

机构地区：[1]郑州大学第一附属医院小儿内科,450052

出　　处：《中华实用儿科临床杂志》2015年第7期541-544,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的 系统评价胸膜腔内注入纤溶剂治疗儿童脓胸的有效性和安全性.方法 系统检索中国期刊全文数据库（CNKI）、中国生物医学数据库、PubMed数据库、中国维普数据库（VIP）、Cochrane图书馆循证医学评价数据库,收集胸膜腔内注入纤溶剂治疗儿童脓胸的随机或半随机对照试验的临床研究.按Cochrane 系统评价标准对纳入研究进行方法学质量评价,对同质研究采用RevMan 5.2软件进行Meta分析,而对不能进行Meta分析的数据则仅进行描述性的定性分析.结果 共纳入5篇随机对照试验（248例）.2项研究（98例）进行了胸膜腔内注入纤溶剂与9 g/L盐水的比较,研究表明胸膜腔内注入纤溶剂相对于9 g/L盐水能够缩短住院时间、减少并发症（P均＜0.05）,而有效率、发热天数和引流液总量在2组间差异无统计学意义（OR=3.61,95％CI0.84 - 15.49,P＞0.05）.3项研究（150例）进行了胸膜腔内注入纤溶剂与电视胸腔镜手术（VATS）的比较,结果显示2组间有效率差异无统计学意义（OR =0.70,95％CI0.30 -0.61,P＞0.05）,但VATS治疗儿童脓胸的花费明显高于胸膜腔内注入纤溶剂（P＜0.05）.5项研究均报道了不良反应,结果显示患儿对纤溶剂的耐受性良好,不良反应多为轻至中度,无严重不良反应.结论 胸膜腔内注入纤溶剂治疗儿童脓胸,尤其是分隔或包裹性脓胸是安全、有效的.与9 g/L盐水相比,能够缩短住院时间、减少并发症;而与VATS相比,二者疗效相近,但纤溶治疗是一种更经济的方法.Objective To evaluate the efficacy and safety of intrapleural fibrinolytic agents in the treatment of childhood empyema.Methods The data from China National Knowledge Infrastructure （CNKI）,Chinese BioMedical （CBM）,PubMed,VIP Database and Cochrane library were reviewed.Randomized control trials by using intrapleural fibrinolytic agents to treat childhood empyema were included.Two reviewers independently extracted the data from the eligible studies and evaluated the quality of the included studies.Meta-analysis was performed for the results of homogeneous studies using RevMan 5.2 software,while others analyzed descriptively.Results Five randomized control trials involving 248 children with empyema were included.Meta-analysis was not made in all of the indexes because of apparent heterogeneity and limited data.Two trials were compared which involved 98 patients receiving fibrinolytic agents or 9 g/L saline.The results suggested that fibrinolytic agents shortened the length of hospital stay and reduced complication（all P 〈 0.05）,but no significant differences were found between the 2 groups in the effective rate,duration of fever and pleural effusion amount（OR =3.61,95% CI 0.84-15.49,P 〉 0.05）.Three trials involving 150 patients compared fibrinolytic agents and video-assisted thoracoscopic surgery （VATS）.The data suggested that no significant differences were found between 2 groups in the effective rate （OR =0.70,95 % CI 0.30-0.61,P 〉 0.05）,but fibrinolytic agents cost less （P 〈 0.05）.The adverse drug reactions to intrapleural fibrinolytic agents were mild to moderate,and well tolerated.Conclusions The findings suggest that intrapleural fibrinolytic agents in the treatment of childhood empyema is safe and effective,especially in encapsulated effusion.Compared to 9 g/L saline,it can shorten the length of hospital stay and reduce complication.Compared with VATS,the curative effect is similar,while intrapleural fibrinolytic agents are economic.

关 键 词：脓胸 纤溶治疗 电视胸腔镜手术 儿童 系统评价 

分 类 号：R726.5[医药卫生—儿科]