Çocuklarda plevral ampiyem ve fibrinolitik tedavi: Tek merkez deneyimi

Year 2020, , 28 - 35, 27.01.2020

Saliha Kanık Yüksek , Belgin Gülhan , Aslınur Özkaya Parlakay , Hasan Tezer Gülşah Bayram Ilıkan Güzin Cinel Can İhsan Öztorun Süleyman Arif Bostancı Vildan Selin Şahin Emrah Şenel

https://doi.org/10.12956/tchd.523491

Abstract

Amaç:
Plevral ampiyem (PA) pnömoninin ciddi bir komplikasyonudur ve önemli bir
problem olmaya devam etmektedir. Farklı tedavi yaklaşımları yayımlanmış birçok
raporda dikkat çekicidir, ancak ideal tedavi için güçlü kanıt sağlamamaktadır.
Bu çalışmada, PA tanısı alan hastalara yaklaşımımızı değerlendirmeyi ve daha
önce yayınlanmış çalışmalarda tam oturmamış tedavi yaklaşımı gölgesinde
merkezimizin deneyimini sunmayı amaçladık.

Gereç ve Yöntemler:
Bu çalışma Ocak 2011-Aralık 2016 tarihleri arasında tek merkezde izlenen 1-17
yaşları arasındaki 48 hastanın değerlendirildiği retrospektif bir çalışmadır.
Hastaların başvuru öncesi durumları, 
riskleri ve tedavileri, başvuru sırasındaki klinik ve laboratuvar
bulguları, seçilmiş tedavi yaklaşımları, özellikle fibrinolitik tedavi ve
komplikasyonlar değerlendirilmiştir.

Bulgular:
Tüp torakostomi 43/48 (% 89,6) hastaya uygulandı. Fibrinolitik tedavi ile
tedavi edilen hastaların sayısı 22 (% 45.8) ve ortalama doz toplamda 5,18 ±
2,59 (1-9) idi. Fibrinolitik tedavi PA evre II'de diğer evrelere göre anlamlı
derecede yüksekti (p = 0.001). Yoğun bakım ihtiyacı % 20,8 (n = 10) iken toplam
hastanede kalış süresi 23,58 ± 8,69 (3-47) gündü. Beş hastada (% 10.4) cerrahi
girişim gerekli oldu. Ameliyat ile hastaların fibrinolitik tedavi durumu
arasında anlamlı ilişki bulunmadı. Komplikasyon oranı toplamda % 41.6 idi.

Sonuç:
Çocuklarda PA'da tedavi yaklaşımı standardize edilmemiştir. Sonuç olarak, her
merkez bizim merkezimizde olduğu gibi önceki deneyimleri ve sonuçları göz
önünde bulundurarak kendi tedavi yaklaşımını uygulamayı tercih ediyor gibi
görünmektedir.

Keywords

Plevral ampiyem; Çocuklar; Fibrinolitik tedavi

Pleural empyema and fibrinolytic therapy in children: A single center experience

Abstract

Objective: Pleural
empyema (PE) is a serious complication of pneumonia and continues to be an
important problem. Different treatment approaches are remarkable in many reports,
but do not provide strong evidence for ideal treatment. In this study, we aimed
to evaluate our approach to the patients diagnosed as PE, and to demonstrate
the experience of our center in the shadow of the not fully seated treatment approach
in previously published studies.

Material and Methods: This
is a retrospective study of 48 patients aged between 1-17 years from January
2011 to December 2016 in one center. Pre-admission status, risks and treatments
of the patients, clinical and laboratory findings on admission, selected
treatment approaches, especially the fibrinolytic therapy, and complications
were evaluated.

Results: Tube
thoracostomy was performed in 43/48 (89.6%). Patients treated with fibrinolytic
therapy was 22 (45.8%) and the mean dose was 5,18±2,59 (1-9) in total.
Fibrinolytic therapy was significantly higher in PE stage (II) than the other
stages (p = 0.001). Intensive care need was 20.8% (n = 10) while total hospital
stay was 23.58 ± 8.69 (3-47) days.  Thoracotomy/decortication or VATS were
required in five (10.4%) patients. There was no significant relationship
between the operation and fibrinolytic treatment status of patients. The
complication rate was 41.6% in total.

Conclussion: The
therapeutic approach to PE in children is not standardized. As a result, each
center seems to prefer to apply its own treatment approach, considering
previous experiences and results, like in our center.

Keywords

Pleural empyema; Children; Fibrinolytic therapy

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