Systematic review of intrapleural fibrinolytic agents in treatment of childhood empyema / 中华实用儿科临床杂志

ABSTRACT

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.