초록
저자들은 패혈증이나 혈액응고장애가 이상이 없는 소방이 형성된 흉막삼출 환자에서 비교적 안전한 것으로 알려진 urokinase의 주입 후에 발생한 혈흉과 이로 인한 hypovolemic shock을 경험하였기에 문헌 고찰과 함께 보고하는 바이다.
Exudative pleural effusion can arise from pneumonia, tuberculosis, cancer, etc. Early drainage is needed for prevention of complications such as pleural fibrosis, thickening, bronchopleural fistulae and decline of lung function. Intrapleural Instillation of fibrinolytic enzymes has been used for 50years as an adjunct in the removal of fibrous material, hematoma and pus from the thoracic cavity. By the local fibrinolytic effect on fibrinous exudates within the pleural space, fibrinolytic agent has improved results of chest tube or pig tail drainage. But there were no controlled randomized studies, so significant controversy exists concerning the efficacy of this therpy, especially tuberculous pleurisy. Furthermore about complication, severe spontaneous bleeding has not been reported with intrapleural urokinase. Intrapleural fibrinolytic enzymes has shows no systemic complication. When it is administrated intravenously, not into intrpleural space, major bleeding is reported about 1-3% of patient, especially they had systemic disease, such as coagulation abnormalities. This case report presents a patient who suffered major hemothorax induced hypovolemic shock following the administration of 100,000 units of urokinase intrapleurally. He was 25-year old male with tuberculosis pleurisy without systemic illness demonstraion.
