Öz
Giriş: Çocukluk çağında ampiyem tedavisi sonrası uzun süreli izlemde akciğer fonksiyonlarının değerlendirilmesi ile ilgili çalışmalar az sayıdadır. Bu çalışmada ampiyemliçocuklarda antibiyotik AB veya antibiyotik + tüp torakostomi TT veya AB+TT+fibrinolitik FT tedavileri sonrası geç dönem solunum fonksiyon testleri sonuçlarının araştırılması amaçlandı.Gereç ve Yöntem: Ampiyem nedeniyle 1-13 yaşlarında tedavi edilmiş 45 olgu çalışmaya alındı. Hastaların yaş, cinsiyet, başlangıç ve izlem süresince saptanan klinikbulguları, radyoloji ve laboratuvar sonuçları, uygulanan tedaviler AB veya AB+TTveya AB+TT+FT incelendi. İzlem süreleri sonunda solunum fonksiyon testleri yapılarak değerlendirildi. Bulgular: Olguların ortalama yaşları ilk başvuruda 6,3±3,3 yaş 1-13 yaş , izlem süresisonunda ortalama 9,3±3,4 yaş 4-17 yaş , ortalama izlem süreleri 30,4±13,5 ay 6-54 ay olarak bulundu. İlk başvurularında ampiyemli olguların 14’ü %31,1 akut eksudatif evre Evre 1 , 19’u %42,2 fibropürülan evre Evre 2 ve 12’si %26,7 kronik organize evre Evre 3 olarak sınıflandırılmıştı. Yirmi bir %46,7 olgu AB, 8 %17,8 olgu AB+TT ve16 %35,5 olgu da AB+TT+FT tedavisi almıştı. İzlem süresinde akciğer grafilerinde 3.ayda 15 %33,3 , 6. ayda 3 %6,6 olguda patolojik bulgu bulundu, 12. ayda tamamı normaldi. Yirmibeş olguya solunum fonksiyon testleri yapılabildi. Bu olguların ortalama izlem süreleri 32,7±11,9 ay idi. Yirmibeş olgunun 3’ünde %12 minimal restriktif bulgularsaptandı, bu 3 olgunun izlem süreleri daha kısa idi 8,3±3,3 ay . Solunum fonksiyontestleri yapılan 25 olgudan 6’sı %24 Evre 1, 12’si %48 Evre 2, 7’si %28 Evre 3 ampiyem olarak sınıflandırılmıştı ve 12 olgu %48 AB, 4 olgu %16 AB+TT, 9 olgu %36 AB+TT+FT tedavisi almıştı. Evrelere ve tedavi yöntemlerine göre olguların VC, FVC,FEV1/FVC, FEV1, FEF25-75% ve PEF değerleri ortalamaları karşılaştırıldığında gruplararasında istatistiksel anlamlı farklılıklar bulunmadı p>0,05 .Sonuç: Çocuklarda ampiyem tedavisi sonrası izlem süresinde 3.- 6. aylar arasında akciğer grafilerinde belirgin düzelmenin gözlendiği ve geç dönemde solunum fonksiyontestlerinin genel olarak normal sınırlar içinde olduğu belirlendi. Sonuçlarımız çocuklarda ampiyem tedavisi sonrası uzun dönemde akciğer fonksiyonlarında belirgin birbozulma gelişmediğini düşündürmektedir
Anahtar Kelimeler
Kaynakça
- 1. Oak SN, Parelkar SV, Satishkumar KV, Pathak R, Ramesh BH, Sudhir S et al. Review of video-assisted thoracoscopy in children. J Minim Access Surg 2009; 5:57-62.
- 2. Michelow IC, Olsen K, Lozano J, Rollins NK, Duffy LB, Ziegler T et al. Epidemiology and clinical characteristics of community-acquired pneumonia in hospitalized children. Pediatrics 2004; 113:701-7.
- 3. Satish B, Bunker M, Seddon P. Management of thoracic empyema in childhood: does the pleural thickening matter? Arch Dis Child 2003; 88:918-21.
- 4. Jaffé A, Balfour-Lynn IM. Management of empyema in children. Pediatr Pulmonol 2005; 40:148-56.
- 5. American Thoracic Society. Management of non-tuberculous empyema. Am Rev Respir Dis 1962; 85:935-6.
- 6. Balfour-Lynn IM, Abrahamson E, Cohen G, Hartley J, King S, Parikh D et al. BTS guidelines for the management of pleural infection in children. Thorax [Suppl] 2005; 60:1-21.
- 7. Eastham KM, Freeman R, Kearns AM, Eltringham G, Clark J, Leeming J et al. Clinical features, aetiology and outcome of empyema in children in the north east of England. Thorax 2004; 59:522-5.
- 8. Kurt BA, Winterhalter KM, Connors RH, Betz BW, Winters JW. Therapy of parapneumonic effusions in children: Video-Assisted Thoracoscopic Surgery versus conventional thoracostomy drainage. Pediatrics 2006; 118:547-53.
- 9. Göçmen A, Kiper N, Toppare M, Ozcelik U, Cengizlier R, Cetinkaya F. Conservative treatment of empyema in children. Respiration 1993; 60:182-5.
- 10. Redding GJ, Walund L, Walund D, Jones JW, Stamey DC, Gibson RL. Lung function in children following empyema. AJDC 1990;144: 1337-42.
- 11. Soto M, Demis T, Landau LI. Pulmonary function following staphylococcal pneumonia in children. Aust Paediatr J 1983; 19:172-4.
- 12. Kohn GL, Walston C, Feldstein J, Warner BW, Succop P, Hardie WD. Persistent abnormal lung function after childhood empyema. Am J Respir Med 2002; 1:441-5.
- 13. Wise MB, Beaudry PH, Bates DV. Long-term follow-up of staphylococcal pneumonia. Pediatrics 1966; 38:398-401.
- 14. McLaughlin FJ, Goldmann DA, Rosenbaum DM, Harris GB, Schuster SR, Strieder DJ. Empyema in children: clinical course and long-term follow-up. Pediatrics 1984; 73:587-93.
- 15. Murphy D, Lockhart CH, Todd JK. Pneumococcal empyema outcome of medikal management. Am J Dis Child 1980; 134:659-62.
- 16. Hoff SJ, Neblett WW, Heller RM, Pietsch JB, Holcomb GW Jr, Sheller JR et al. Postpneumonic empyema in childhood: selecting appropriate therapy. J Pediatr Surg 1989; 24:659-64.
- 17. Montgomery M. Air and liquid in the pleural space. In: Chernick V, Boat TF (eds). Kendig’s Disorders of the Respiratory Tract in Children: Disorders of the pleura. 6th edition. Philadelphia: WB Saunders Company; 1998. p. 389-411.
- 18. Winterbauer RH. Nonmalignant pleural effusions. In: Fishman AP, Elias JA, Fishman JA et al (eds). Fishman’s Pulmonary Diseases and Disorders: Parapneumonic effusions and/or empyema. 3rd edition. New York: The Mc Graw-Hill Companies; 1998. p. 1412-7.
- 19. Light RW. A new classification of parapneumonic effusions and empyema. Chest 1995; 108:299-301.
- 20. Kurland G. Pleural effusion, empyema, and chylothorax. In: Burg FD, Wald ER, Ingelfinger JR, Polin RA (eds). Current Pediatric Therapy: Empyema. 16th edition. Philadelphia: WB Saunders Company; 1999. p. 933-5.
- 21. Light RW. The physiology of pleural fluid production and benign pleural effusion. In: Shields TW (eds). General Thoracic Surgery: The pleura. 4th edition. New York: Williams & Wilkins; 1994. p. 674-8.
- 22. K›l›ç N, Çelebi S, Gürp›nar A, Hacimustafaoglu M, Konca Y, Ildirim I et al. Management of thoracic empyema in children. Pediatr Surg Int 2002; 18:21-3.
- 23. Temes RT, Follis F, Kessler RM, Pett SB, Wernly JA. Intrapleural fibrinolytics in management of empyema thoracis. Chest 1996; 110:102-6.
- 24. Chin NK, Lim TK. Controlled trial of intrapleural streptokinase in the treatment of pleural empyema and complicated parapneumonic effusions. Chest 1997; 111:275-9.
- 25. Rosen HE, Nadkarni V, Theroux M, Padman R, Klein J. Intrapleural streptokinase as adjunctive treatment for persistent empyema in pediatric patients. Chest 1993; 103:1190-3.
- 27. Boomsma JD, Glassroth J. Mechanics of breathing. In: Shields TW (eds). General Thoracic Surgery: Lung volume measurements. 4th edition. New York: Williams & Wilkins; 1994. p. 120-8.
- 28. Chan W, Gauvin-Keyser E, Davis GM, Nguyen LT, Laberge JM. Empyema thoracis in children: A 26-year review of the Montreal Children’s Hospital experience. J Pediatr Surg 1997; 32:870-2.
- 29. Çaksen H, Öztürk MK, Yüksel fi, Üzüm K, Üstünbafl HB. Parapnömonik plevral effüzyon ve ampiyem: 68 vakan›n retrospektif olarak de¤erlendirilmesi. Çocuk Sa¤l›¤› ve Hastal›klar› Dergisi 1999; 42:215-25.
- 30. Doski JJ, Lou D, Hicks BA, Megison SM, Sanchez P, Contidor M et al. Management of parapneumonic collections in infants and children. J Pediatr Surg 2000; 35:265-70.
Öz
Introduction: Studies on lung functions at the long term follow-up of pleural empyema treatment in children are limited. The aim of this study was to evaluate the longterm pulmonary function test results in childhood empyema cases treated with antibiotic AB or AB+tube thoracostomy TT or AB+TT+fibrinolytics FT . Materials and Method: In this study, 45 cases 1 to 13 years old treated for empyemawere included. The age, gender, clinical characteristics, radiological findings and laboratory results at baseline and during the follow-up periods and the treatment modalities AB or AB+TT or AB+TT+FT were evaluated. Pulmonary function tests were performed at the end of the follow-up periods. Results: The mean ages at baseline and at the end of follow-up period of 30.4±13.5 months were 6.3±3.3 years and 9.3±3.4 years, respectively. Stages of the disease at admission was acute exudative stage 1 in 14 31.1% cases, fibrinopurulent stage 2 in 19 42.2% and chronic organizing stage 3 in 12 26.7% . Twenty one cases 46.7% were treated with AB, 8 17.8% with AB+TT and 16 35.5% with AB+TT+FT. Chest roentgenograms showed abnormal findings in 15 cases 33.3% at the 3rdmonth, in 3 cases 6.6% at the 6thmonth and none at the 12thmonth. Pulmonary function tests were available in 25 children. The mean follow-up period of these cases was 32.7±11.9 months after the empyema treatment. Three cases 12% with a shorter mean follow-up 8.3±3.3 months had minimal restrictive patterns. Six of25 24% cases having pulmonary function tests were classified as stage 1, 12 48% as stage 2, and 7 28% as stage 3 empyema at admission. Of 25 cases having pulmonary function tests, 12 48% were treated with AB, 4 16% withAB+TT and 9 36% with AB+TT+FT. Mean VC, FVC, FEV1/FVC, FEV1, FEF25-75% and PEF values did not significantly differaccording to stages and treatment modalities p>0.05 .Conclusion: It was seen that after the treatment of empyema, remarkable improvements were seen in chest roentgenographic findings between 3rdand 6thmonths and in general, pulmonary function tests revealed normal resultsin long term. Our results suggest that lung functions are not significantly compromised at long term after empyema
Anahtar Kelimeler
Kaynakça
- 1. Oak SN, Parelkar SV, Satishkumar KV, Pathak R, Ramesh BH, Sudhir S et al. Review of video-assisted thoracoscopy in children. J Minim Access Surg 2009; 5:57-62.
- 2. Michelow IC, Olsen K, Lozano J, Rollins NK, Duffy LB, Ziegler T et al. Epidemiology and clinical characteristics of community-acquired pneumonia in hospitalized children. Pediatrics 2004; 113:701-7.
- 3. Satish B, Bunker M, Seddon P. Management of thoracic empyema in childhood: does the pleural thickening matter? Arch Dis Child 2003; 88:918-21.
- 4. Jaffé A, Balfour-Lynn IM. Management of empyema in children. Pediatr Pulmonol 2005; 40:148-56.
- 5. American Thoracic Society. Management of non-tuberculous empyema. Am Rev Respir Dis 1962; 85:935-6.
- 6. Balfour-Lynn IM, Abrahamson E, Cohen G, Hartley J, King S, Parikh D et al. BTS guidelines for the management of pleural infection in children. Thorax [Suppl] 2005; 60:1-21.
- 7. Eastham KM, Freeman R, Kearns AM, Eltringham G, Clark J, Leeming J et al. Clinical features, aetiology and outcome of empyema in children in the north east of England. Thorax 2004; 59:522-5.
- 8. Kurt BA, Winterhalter KM, Connors RH, Betz BW, Winters JW. Therapy of parapneumonic effusions in children: Video-Assisted Thoracoscopic Surgery versus conventional thoracostomy drainage. Pediatrics 2006; 118:547-53.
- 9. Göçmen A, Kiper N, Toppare M, Ozcelik U, Cengizlier R, Cetinkaya F. Conservative treatment of empyema in children. Respiration 1993; 60:182-5.
- 10. Redding GJ, Walund L, Walund D, Jones JW, Stamey DC, Gibson RL. Lung function in children following empyema. AJDC 1990;144: 1337-42.
- 11. Soto M, Demis T, Landau LI. Pulmonary function following staphylococcal pneumonia in children. Aust Paediatr J 1983; 19:172-4.
- 12. Kohn GL, Walston C, Feldstein J, Warner BW, Succop P, Hardie WD. Persistent abnormal lung function after childhood empyema. Am J Respir Med 2002; 1:441-5.
- 13. Wise MB, Beaudry PH, Bates DV. Long-term follow-up of staphylococcal pneumonia. Pediatrics 1966; 38:398-401.
- 14. McLaughlin FJ, Goldmann DA, Rosenbaum DM, Harris GB, Schuster SR, Strieder DJ. Empyema in children: clinical course and long-term follow-up. Pediatrics 1984; 73:587-93.
- 15. Murphy D, Lockhart CH, Todd JK. Pneumococcal empyema outcome of medikal management. Am J Dis Child 1980; 134:659-62.
- 16. Hoff SJ, Neblett WW, Heller RM, Pietsch JB, Holcomb GW Jr, Sheller JR et al. Postpneumonic empyema in childhood: selecting appropriate therapy. J Pediatr Surg 1989; 24:659-64.
- 17. Montgomery M. Air and liquid in the pleural space. In: Chernick V, Boat TF (eds). Kendig’s Disorders of the Respiratory Tract in Children: Disorders of the pleura. 6th edition. Philadelphia: WB Saunders Company; 1998. p. 389-411.
- 18. Winterbauer RH. Nonmalignant pleural effusions. In: Fishman AP, Elias JA, Fishman JA et al (eds). Fishman’s Pulmonary Diseases and Disorders: Parapneumonic effusions and/or empyema. 3rd edition. New York: The Mc Graw-Hill Companies; 1998. p. 1412-7.
- 19. Light RW. A new classification of parapneumonic effusions and empyema. Chest 1995; 108:299-301.
- 20. Kurland G. Pleural effusion, empyema, and chylothorax. In: Burg FD, Wald ER, Ingelfinger JR, Polin RA (eds). Current Pediatric Therapy: Empyema. 16th edition. Philadelphia: WB Saunders Company; 1999. p. 933-5.
- 21. Light RW. The physiology of pleural fluid production and benign pleural effusion. In: Shields TW (eds). General Thoracic Surgery: The pleura. 4th edition. New York: Williams & Wilkins; 1994. p. 674-8.
- 22. K›l›ç N, Çelebi S, Gürp›nar A, Hacimustafaoglu M, Konca Y, Ildirim I et al. Management of thoracic empyema in children. Pediatr Surg Int 2002; 18:21-3.
- 23. Temes RT, Follis F, Kessler RM, Pett SB, Wernly JA. Intrapleural fibrinolytics in management of empyema thoracis. Chest 1996; 110:102-6.
- 24. Chin NK, Lim TK. Controlled trial of intrapleural streptokinase in the treatment of pleural empyema and complicated parapneumonic effusions. Chest 1997; 111:275-9.
- 25. Rosen HE, Nadkarni V, Theroux M, Padman R, Klein J. Intrapleural streptokinase as adjunctive treatment for persistent empyema in pediatric patients. Chest 1993; 103:1190-3.
- 27. Boomsma JD, Glassroth J. Mechanics of breathing. In: Shields TW (eds). General Thoracic Surgery: Lung volume measurements. 4th edition. New York: Williams & Wilkins; 1994. p. 120-8.
- 28. Chan W, Gauvin-Keyser E, Davis GM, Nguyen LT, Laberge JM. Empyema thoracis in children: A 26-year review of the Montreal Children’s Hospital experience. J Pediatr Surg 1997; 32:870-2.
- 29. Çaksen H, Öztürk MK, Yüksel fi, Üzüm K, Üstünbafl HB. Parapnömonik plevral effüzyon ve ampiyem: 68 vakan›n retrospektif olarak de¤erlendirilmesi. Çocuk Sa¤l›¤› ve Hastal›klar› Dergisi 1999; 42:215-25.
- 30. Doski JJ, Lou D, Hicks BA, Megison SM, Sanchez P, Contidor M et al. Management of parapneumonic collections in infants and children. J Pediatr Surg 2000; 35:265-70.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Research Article |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Haziran 2010 |
| Yayımlandığı Sayı | Yıl 2010 Cilt: 8 Sayı: 1 |