肺部感染的第一线医疗胸腔镜:SPIRIT随机对照可行性试验
Krishan Ragab Bansal1,2, David T Arnold3,4, Emma Tucker3,4
1Respiratory Medicine, University of Bristol Academic Respiratory Unit, Bristol, UK krb48@cantab.ac.uk.
BMJ open respiratory research
|December 10, 2025
概括
一项可行性试验发现,根据目前的协议,在英国国家卫生服务 (NHS) 中,不太可能进行全面的随机对照试验 (RCT),将医学胸腔镜 (MT) 与胸部排水管插入用于肺部感染.
科学领域:
- 肺部病理学 肺部病理学
- 胸部外科手术 胸部外科手术
- 关键护理医学 关键护理医学
背景情况:
- 胸腔感染是一个重大的临床挑战,通常需要住院治疗,使用抗生素和插入胸腔排水管.
- 医学胸腔镜 (MT) 基于回顾性数据显示出急性胸腔感染的前景,但缺乏前性随机对照试验 (RCT) 评估作为英国的一线治疗.
- SPIRIT试验的目的是评估在英国国家卫生服务 (NHS) 医院进行全面RCT的可行性,将MT与胸腔排水插入用于急性肺部感染.
研究的目的:
- 评估进行大规模随机对照试验 (RCT) 的可行性,将医疗胸腔镜 (MT) 与急性肺部感染的标准胸腔排水插入进行比较.
- 为了确定潜在的未来最终试验的招聘率,选失败原因和分配成功.
主要方法:
- 一个开放的,随机的可行性试验 (SPIRIT) 在七个NHS中心 (2017-2019) 进行.
- 怀疑肺部感染的成年人被预先查并随机分配到胸部排水插入或MT.
- 通过预先查,查和分配失败率来评估可行性;二级结果包括停留时间,死亡率和不良事件.
主要成果:
- 主要可行性终点未达到,排除率高 (93.8%),主要是由于缺乏MT可用性或非感染的输出.
- 十二名符合条件的患者被随机分配;医疗胸腔镜 (MT) 程序略长,但胸部排水器保持更长时间.
- 放射性改善,微生物学产量和症状得分在各组之间是可比的,不良事件的发生率较低.
结论:
- 在NHS环境中,与当前的协议相比,完全规模的RCT比较MT和胸部排水插入的肺部感染不太可能是可行的.
- 有针对性的招聘策略和利用已建立紧急MT能力的中心可能会提高未来试验的可行性.
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