How to treat pleural effusion

In order to treat pleural effusion, many patients will fall into frustration and entanglement because they don’t know which method can effectively solve the problem. In fact, common methods include medication and fluid extraction, but any method must be decided based on clinical symptoms.

1. Tuberculous pleural effusion

(1) Anti-tuberculosis drug treatment (see the chapter on pulmonary tuberculosis).

(2) Thoracentesis: Moderate or more effusion requires therapeutic thoracentesis to relieve or eliminate the symptoms of pulmonary and cardiovascular compression, reduce fibrin deposition and pleural thickening, and reduce or avoid the possibility of affecting lung function. In addition, fluid extraction therapy can alleviate the toxic symptoms of tuberculosis. The amount of fluid drawn each time should not exceed 1000 ml, and it should not be too fast or too much, so as to avoid a sudden drop in chest pressure and the occurrence of pulmonary edema after re-expansion. If dizziness, pale face, sweating, palpitations, and cold limbs occur during the extraction process, it is considered a "pleural reaction" and the operation should be stopped immediately, and the patient should be laid flat. Changes in blood pressure and other symptoms should be closely observed. If necessary, 0.375g of nikethamide (coramine) should be injected intramuscularly or 0.5ml of 0.1% epinephrine should be injected subcutaneously.

2. Malignant pleural effusion Malignant pleural effusion is one of the most common pleural effusions. Among them, metastasis of lung cancer, breast cancer, lymphoma, and ovarian cancer is the most common cause of malignant pleural effusion.

(1) Systemic anti-tumor chemotherapy: Malignant pleural effusion is not limited to the pleural cavity (except for primary pleural malignant tumors). Therefore, for malignant tumors that are more sensitive to systemic anti-tumor chemotherapy, such as small cell lung cancer, malignant lymphoma, breast cancer, etc., the pleural effusion disappears in about 1/3 of patients after systemic chemotherapy.

(2) Local treatment of the thoracic cavity

① Injection of anti-tumor drugs into the pleural cavity: usually intercostal incision and drainage are used to empty the pleural effusion as much as possible, and anti-tumor drugs are injected through the drainage tube, such as cisplatin (cisplatin) 40-80 mg, doxorubicin (adriamycin) 30 mg, mitomycin 10-20 mg, bleomycin 60 mg, 5-fluorouracil (5-fluorouracil) 750-1000 mg, etc., which can not only kill cancer cells, but also cause pleural adhesion.

② Injection of biological immunomodulators into the pleural cavity: such as Corynebacterium brevis (cp), Streptococcus 722 preparation (Sapellin 0K-432), Cytokine, IL-2, interferon, lymphokine-activated killer cells (LAK cells), and tumor infiltrating lymphocytes (TIL).

3. Purulent pleural effusion (abbreviated as empyema) Empyema often occurs secondary to purulent infection or trauma. The main infectious pathogens include Staphylococcus aureus, anaerobic bacteria, Gram-negative bacilli, Mycobacterium tuberculosis, actinomycetes, etc.

In the acute stage of empyema, strong anti-infection treatment should be given (systemic and local intrathoracic administration). Pleural pus should be actively drained. Repeated thoracentesis or intercostal incision and drainage can be performed, and the chest cavity should be repeatedly flushed with 2% sodium bicarbonate, and then antibiotics or anti-tuberculosis drugs (tuberculous empyema) should be injected. Streptokinase is injected into the chest cavity to thin the pus and facilitate drainage. For patients with bronchopleural fistula, chest lavage is not recommended to avoid suffocation.