Objective: To study the effect of sodium hyaluronate (SH) on pleural adhesions and fibrosis in experimental empyema.
Methods: Twenty rabbits were randomly divided into two groups: a treatment group and a control group, 10 rabbits in each group. Chest tubes were placed into the right pleural cavity of the rabbits. Empyema was induced via intrapleural injection of turpentine followed by instillation of 10(8) CFU Staphylococcus aureus into the pleural space 3 h later. After an empyema was verified by pleural fluid analysis at 24 h, SH 3 ml (30 mg) was introduced into the right pleural cavity in the treatment group, but normal saline 3 ml was used in the control group. The rabbits received procaine penicillin G, 200 000 U intramuscularly daily after 24 h. Pleural effusion was analyzed at 24 h and 96 h. All animals were sacrificed on Day 8.
Results: Eighteen rabbits completed the experiment, 9 rabbits in each group. Pleural fluid analysis at 96 h in the treatment group and the control group showed that, leukocyte count was (24.7 +/- 13.0) x 10(9)/L and (36.9 +/- 10.1) x 10(9)/L, respectively; neutrophil percentage was (27.1 +/- 11.2)% and (49.6 +/- 10.9)%, respectively; protein was (30.1 +/- 3.6) g/L and (35.6 +/- 4.3) g/L, respectively. The three parameters of the treatment group were significantly lower than those of the control group (P < 0.05). The level of glucose was (2.44 +/- 0.52) mmol/L at 96 h in the treatment group and significantly higher than the control group (3.78 +/- 1.28) mmol/L (P < 0.05). In the treatment group and the control group the pleurodesis score was 0.7 +/- 0.5 and 3.2 +/- 0.7, respectively; visceral pleural thickness score was (28 +/- 10) microm and (156 +/- 42) microm, respectively; and fibroblast score was (37 +/- 15)/mm(2) and (163 +/- 58)/mm(2), respectively. The above parameters of the treatment group were significantly lower than those of the control group.
Conclusion: Early intrapleural injection of a high molecular weight SH was safe and effective in decreasing pleural adhesions and fibrosis in a rabbit model of empyema.
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