利用肋膜間投與纖維蛋白溶解藥物如尿素激?已被應用為治療兒童複雜性肺炎併發肋膜積水和膿胸的一種有效的附加治療方法。在這篇研究中，我們描述關於使用尿素激?用來治療兒童複雜性肺炎併發肋膜積水的經驗。我們回顧13個（平均年齡50.8月）有複雜性肺炎併發肋膜積水或膿胸的病童因對於抗生素和閉管式胸管引流的治療反應不佳，再接受肋膜間投與尿素激?治療的個案。另外收集13個（平均年齡45.8月）有相同疾病情況的住院病童，皆未使用尿素激?治療者作為對照組。使用肋膜間尿素激?療法的病童，在投與尿素激後，最初的24與72小時的肋膜液引流量顯著的多於尿素激?投與前24小時的引流量(p=0.002與p<0.001)。接受肋膜間投與尿素激?治療的病童其總肋膜液引流量亦顯著的多於對照組病童(p<0.001)。接受肋膜間尿素激?治療的病童平均胸管放置引流天數與病童平均總住院天數分別顯著的短於對照組病童（8.7±2.8 days vs. 14.7±6.1 days, p<0.02與15.5±5.3 days vs. 24.4±6.9 days, p=0.002）。13個病人都能成功的以尿素激?治療改善其肋膜液引流與臨床情況。這13位病童亦沒有發生任何副作用或不適。而對照組中有兩位病童最後需要接受外科清除手術。結論，對於併有複雜性肺炎併發肋膜積水的病童使用肋膜間投與尿素激?是一種有效且安全的附加治療方法。
Intrapleural instillation of fibrinolytic agent such as urokinase has been shown to be effective as an adjunctive therapy for children with complicated parapneumonic effusion and empyema. In this study, we described our experience with the use of intrapleural urokinase in the management of complicated parapneumonic effusion in children. We collected 13 patients with a mean age of 50.8 months with parapneumonic pleural effusion or empyema; all were treated with intrapleural urokinase after poor response to appropriate antibiotics and simple tube drainage. We also reviewed another 13 patients with a mean age of 45.8 months from the clinical records of children hospitalized with the same conditions prior to urokinase introduction as a control group. The mean fluid drained during the first 24 hours and the first 72 hours after urokinase instillation were significantly greater than those during 24 hours before instillation, p=0.002 and p<0.001, respectively. The total volume of fluid drained was also greater in the urokinase group than that in the control group (p=0.001). The mean duration of chest tube drainage was significantly shorter in the urokinase group (8.7±2.8 days vs. 14.7±6.1 days, p<0.02). The mean length of hospitalization was also significantly shorter in the urokinase group (15.5±5.3 days vs. 24.4±6.9 days, p=0.002). All 13 patients were managed successfully with urokinase treatment without further surgical procedures. None of the patients experienced any side effect or adverse event after urokinase instillation. Two patients of the control group finally underwent surgical debridement. In conclusion, the use of intrapleural urokinase treatment in children with complicated parapneumonic effusion is an effective and safe therapy.
