補內胎 治 氣胸 將改寫 治療準則 !

氣胸打「眼藥膏」補破胎 老藥新用途！【聯合晚報╱記者李樹人/台北報導】 2013.03.14 02:55 pm 老藥新用途！俗稱「眼藥膏」的傳統抗生素四環黴素，現在可用來預防自發性氣胸患者再度破洞。台大、亞東研究團隊發現，氣胸患者第一次插管治療時，將四環黴素靜脈注射劑型打入胸腔，就能使肺腔與胸壁緊黏，達到「補破胎」效果，降低四成復發機率。據統計，自發性氣胸常發生於身材瘦高的年輕男性，嚴重時甚至有生命危險。台灣每年超過2000名自發性氣胸病患，需接受插胸管排除空氣或手術治療。國際治療準則建議，第一次發作的自發性氣胸，應考慮以細針或胸管排除空氣。新當選台大校長的台大醫學院院長楊泮池，今天率領醫療團隊發表臨床試驗成果。他指出，臨床顯示，傳統方法失敗率偏高，氣胸復發機率高達50%。而台大醫院醫療團隊主導的雙醫學中心大規模臨床試驗有突破性發現，改寫國際氣胸治療準則，研究結果刊登於國際頂尖醫學期刊《刺胳針》。台大醫院外科部胸腔外科副教授陳晉興指出，眼藥膏是最常見、最老的抗生素，質地黏稠，做成靜脈注射劑型名稱改為「美諾四環素」，黏性超強，原本作為肋膜沾粘劑。這項氣胸研究則發現，如用來黏合胸腔肺破洞，可降低四成復發機率。這項研究係由楊泮池帶領外科、內科、急診醫學及臨床試驗中心團隊，從2006年至2012年，在台大醫院、亞東醫院急診部進行大規模臨床試驗，五年多來共收案214名病患。急診醫師在收治第一次自發性氣胸患者插管抽氣後，隨即額外注入肋膜沾粘劑「美諾四環素」，再行觀察追蹤日後沾粘情況及氣胸復發機率。結果發現，傳統老藥抗生素能夠發揮極大的黏合效果，效果如同強力膠一樣，可以緊緊黏住胸壁及肺腔，讓氣胸復發率從原本的49%降至29%，日後需接受手術治療機率也從44% 降至29%。陳晉興以「補內胎」來形容這項新技術，他表示，肺部就像是內胎，胸壁則為外胎，內胎破了就必須先用強力膠來修補破洞，如果沒修好，未來「消風」的機率當然會大增。【2013/03/14 聯合晚報】

Simple aspiration and drainage and intrapleural minocycline pleurodesis versus simple aspiration and drainage for the initial treatment of primary spontaneous pneumothorax: an open-label, parallel-group, prospective, randomised, controlled trial   The Lancet, Early Online Publication, 18 February 2013

Background Simple aspiration and drainage is a standard initial treatment for primary spontaneous pneumothorax, but the rate of pneumothorax recurrence is substantial. We investigated whether additional minocycline pleurodesis after simple aspiration and drainage reduces the rate of recurrence. Methods In our open-label, parallel-group, prospective, randomised, controlled trial at two hospitals in Taiwan, patients were aged 15—40 years and had a first episode of primary spontaneous pneumothorax with a rim of air greater than 2 cm on chest radiographs, complete lung expansion without air leakage after pigtail catheter drainage, adequate haematological function, and normal renal and hepatic function. After simple aspiration and drainage via a pigtail catheter, patients were randomly assigned (1:1) to receive 300 mg of minocycline pleurodesis or no further treatment (control group). Randomisation was by computer-generated random numbers in sealed envelopes. Our primary endpoint was rate of pneumothorax recurrence at 1 year. This trial is registered with ClinicalTrials.gov (NCT00418392). Findings Between Dec 31, 2006, and June 30, 2012, 214 patients were randomly assigned—106 to the minocycline group and 108 to the control group (intention-to-treat population). Treatment was unsuccessful within 7 days of randomisation in 14 patients in the minocycline group and 20 patients in the control group. At 1 year, pneumothoraces had recurred in 31 of 106 (29·2%) patients in the minocycline group compared with 53 of 108 (49·1%) in the control group (p=0·003). We noted no procedure-related complications in either group. Interpretation Simple aspiration and drainage followed by minocycline pleurodesis is a safe and more effective treatment for primary spontaneous pneumothorax than is simple aspiration and drainage only. Minocycline pleurodesis should be an adjunct to standard treatment for primary spontaneous pneumothorax. Funding Department of Health and National Science Council, Taiwan.