Can İhsan ÖZTORUN, Emrah ŞENEL, Belgin GÜLHAN, Saliha KANIK YÜKSEK, Gülşah BAYRAM ILIKAN, Vildan Selin ŞAHİN, Aslınur ÖZKAYA PARLAKAY, Hasan TEZER, Süleyman Arif BOSTANCI, Güzin CİNEL

Çocuklarda plevral ampiyem ve fibrinolitik tedavi: Tek merkez deneyimi

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.

Anahtar Kelimeler:

Plevral ampiyem; Çocuklar; Fibrinolitik tedavi

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

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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