贵州医科大学学报

2018, v.43;No.216(09) 1105-1108+1113

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胸腔闭式引流治疗结核性胸膜炎的临床疗效
Clinical Curative Effect of Closed Thoracic Drainage on Encapsulated Tuberculous Pleurisy

张艳丽;武丽;张贵贤;李福建;
ZHANG Yanli;WU Li;ZHANG Guixian;LI Fujian;Department of Tuberculosis,Baoding Infectious Diseases Hospital;

摘要(Abstract):

目的:探讨早期使用中心静脉导管胸膜腔闭式引流治疗结核性胸膜炎的临床疗效。方法:将接受抗结核治疗并使用中心静脉导管胸膜腔闭式引流的64例患者分为用生理盐水冲洗的非包裹性积液患者组(非包裹性积液组,n=20)、用尿激酶注入的包裹性积液组(尿激酶组,n=22)和用生理盐水注入的包裹性积液组(盐水组,n=22),连续3 d进行胸腔灌洗并引流,记录3组患者发热和呼吸困难缓解时间、胸水引流量、引流管留置时间及平均住院时间;治疗6个月时超声检查判定临床疗效,随访12个月,通过X线或B超观察比较3组患者出院时、治疗第6个月、9个月、12个月时胸膜腔积液消失时间、胸片和肺功能变化、胸膜肥厚发生率;采用肺功能检测仪测定用力肺活量占预计值的百分比(FVC%pred),同时记录置管后不良反应。结果:3组患者的发热和呼吸困难症状均改善,非包裹性积液组和尿激酶组缓解呼吸困难所需的时间明显短于盐水组(P <0. 05),胸水引流量大于盐水组(P <0. 05),盐水组患者的平均住院时间比非包裹性积液组和尿激组延长(P <0. 05),3组患者治疗6个月后的痊愈率和总有效率比较,非包裹性积液组和尿激组高于盐水组,差异有统计学意义(P <0. 05);在各个随访的时间点,尿激酶组胸片和肺功能变化与盐水组比较均有改善,差异有统计学意义(P <0. 05);非包裹性积液组和尿激酶组患者胸膜肥厚的发生率低于在盐水组,差异有统计学意义(P <0. 05);各组患者随访期间未发生可导致治疗终止的不良反应。结论:早期胸腔闭式引流及注入尿激酶治疗,可使胸腔积液快速清除,促进肺功能恢复及减少胸膜肥厚的发生。
Objective: To investigate the clinical effect of early use of central venous catheters in closed thoracic drainage for packaged tuberculous pleural effusion. Methods: 64 Patients with tuberculous pleurisy( TP) were divided into 3 groups: the non-encapsulated pleural effusion group( treated with injection of saline),the urokinase group( group of encapsulated pleural effusion treated with central venous catheters for closed thoracic drainage) and the saline group( group of encapsulated pleural effusion treated with injection of saline). The 3 treatments were conducted for 3 days consecutively with thoracic lavage,with 12 months' follow-up. X-ray changes in the lungs of the three groups were observed 6 months,9 months and 12 months after treatment. The ultrasound was performed for 6 months so as to measure and determine the clinical efficacy,the pleural hypertrophy incidence,the changes of lung function and the ratio of forced vital capacity( FVC% pred). Results: The average hospital stay of the saline group was longer than that of the non-encapsulated effusion group and the urokinase group( P < 0. 05). In the time of follow-up,the urokinase group showed significant improvement of chest and lung functions compared with the saline group and the difference was statistically significant( P < 0. 05). The incidence of pleural hypertrophy in the non-encapsulated effusion group and the urokinase group was lower than that in the saline group( P < 0. 05). After 6 months' treatment the curative rate and total effective rate in the non-encapsulated effusion group and the urokinase group were higher than those in the saline group,and the difference was statistically significant( P < 0. 05).There was no adverse reaction that led to the termination of treatment during the follow-up period.Conclusion: Early closed thoracic drainage and injection of urokinase can rapidly remove pleural effusion,promote lung function and reduce pleural hypertrophy.

关键词(KeyWords): 胸膜疾病;胸腔积液;胸管;引流术;结核;尿激酶
pleural diseases;pleural effusion;chest tubes;drainage;tuberculosis;urokinase

Abstract:

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基金项目(Foundation): 保定市科技计划项目(17zf080)

作者(Author): 张艳丽;武丽;张贵贤;李福建;
ZHANG Yanli;WU Li;ZHANG Guixian;LI Fujian;Department of Tuberculosis,Baoding Infectious Diseases Hospital;

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