Taner YAVUZ, Neşe ERSÖZ, Alev AKTAŞ, Kenan KOCABAY

Çocuklarda toraks ampiyeminde streptokinaz tedavisi

Amaç: Çocuklarda toraks ampiyeminin tedavisinde intraplevral streptokinazın rolünü değerlendirmek. Gereç ve Yöntem: Mayıs 2002 ile Haziran 2003 arasında toraks ampiyemi olan 9 çocuk kapalı tüp drenajı ve antibiyotikle tedavi edildi. Bu çocuklardan 4'ü medikal tedaviye yanıtsızdı ve intraplevral Streptokinaz uygulandı. 100 mL serum fizyolojikle sulandırılan 250,000 ünite Streptokinaz günde tek doz olarak 3 gün süreyle interkostal tüpten verildi. Tedavi yanıtı klinik seyir, drene edilen sıvının ölçümü ve takipte çekilen toraks grafisi, ultrasonografi ve/veya bilgisayarlı tomografi ile değerlendirildi. Bulgular: Tüm vakalar 3 günlük Streptokinaz tedavisine interkostal tüp drenajında artış, semptomlarda gerileme ve takipte çekilen görüntüleme teknikleriyle gösterilen ampiyemin tam rezolüsyonu ile yanıt verdiler. Vakaların hepsinde kısa süren ateş için oral analjezik gereksinimi oldu. Hiçbir vakada başka bir yün etki gelişmedi. Sonuç: Çalışma konservatif tedaviye yanıtsız toraks ampiyemli seçilmiş vakalarda intraplevral Streptokinaz uygulamasının etkili olduğunu göstermektedir. Streptokinaz tedavisi cerrahi tedavi gereksinimini azaltmak için dekortikasyon adaylarında düşünülmelidir. Bununla birlikte, ilacın verilme zamanı, dozajı ve uzun dönem yan etkilerini değerlendirmek için kontrollü çalışmalara gereksinim vardır.

Anahtar Kelimeler:

Streptokinaz, Ampiyem, plevral, Çocuk, Tedavi sonucu, İlaç uygulama programı

Treatment of thoracic empyema with steptokinase in children

Aim: To evaluate the role of intrapleural Streptokinase in the management of thoracic empyema in children. Material and Methods: Between May 2002 and June 2003, 9 children with thoracic empyema were treated with closed-tube drainage and antibiotics, among them 4 who failed to respond to therapy were treated with intrapleural Streptokinase. A dose of 250,000 units of Streptokinase in 100 mL normal saline were instilled once a day via the intercostal tube for 3 days. Response was assessed by clinical outcome, measurement of drain output, and subsequent chest radiography, pleural ultrasound and/or CT. Results: All subjects responded to 3 days of Streptokinase instillation, with increased intercostal tube drainage, clinical resolution of symptoms, and complete resolution of the empyema was shown on subsequent imaging techniques. All subjects needed oral analgesics for short lasting fever. None of the subjects experienced any other side effects. Conclusion: The study shows that intrapleural Streptokinase instillation appears to be an efficient treatment in selected cases of thoracic empyema resistant to conservative treatments. Its use should be considered in potential decortication candidates in an effort to reduce the need for surgery. Nevertheless, controlled studies are needed to assess timing of administration techniques, dosage for Streptokinase administration, and long term side effects.

Keywords:

Streptokinase, Empyema, Pleural, Child, Treatment Outcome, Drug Administration Schedule,

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