胸膜腔内注入纤溶剂治疗渗出性胸膜炎的研究进展

纤维蛋白溶解剂胸膜腔注入辅助治疗渗出性胸膜炎在临床上较大规模应用已有20年历史,最近5年之前的主要文献均肯定了其疗效,认为其可以促进引流,减少外科手术十预率,缩短住院时间及降低费用,但2005年英国牛津的一个迄今最大规模的胸膜腔注入链激酶治疗感染性胸水的前瞻性双盲对照试验则否定了这一结论,目前这一疗法的临床前景仍有待明确.一些新型纤溶剂及辅助引流胸水药物的研究已取得一些进展,但仍未见应用于人体,需要试验来验证其治疗作用.我国的研究应用主要是用尿激酶治疗结核性胸水.但只局限于临床指标的观察,尚缺乏检测应用尿激酶后胸水纤维蛋白、流变性等性状指标改变的实验数据支持研究结果.

Research progress of intrapleural fibrinolytics agents in exudative pleurisy

There has being twenty years up to now from relative large scale clinical application of intrapleural fibrinolytics agents in the adjuvant therapy of exudative pleurisy. Majority literatures before the last five years uniformly confirmed the therapeutic effect, which considered that fibrinolytics agents could enhance pleural fluid drainage.reduce the rate of surgical intervention,shorten length of stay and cut down cost of hospitalization. However, the largest prospective double-blind controlled study in Oxford up to now on the role of intrapleural streptokinase in infectious pleural effusion denied this conclusion. At present,this therapeutic clinical prospect remains to be clarified. Some studys about new fibrinolytics agents and auxiliary substances of pleural fluid drainage have been made progress,but not been applied in humans. Additional investigations are needed to evaluate the therapeutic effect. Majority researchs about intrapleural fibrinolytics agents in China are to use intrapleural urokinase for tuberculous pleural effusion, but they are only limited in clinical indicators. There have been no experimental data about pleural fluid fibrin and rheological parameters after intrapleural urokinase to support the research.