胸腔注射尿激酶减少结核性渗出性胸膜炎胸膜粘连的效果观察

Study on treatment effect of intrapleural urokinase for tuberculous pleurisy

目的 观察胸腔注射尿激酶减少结核性渗出性胸膜炎胸膜粘连的效果。方法 收治渗出性胸膜炎 12 0例。随机分成治疗组与对照组各 6 0例。治疗组第 1、2、3次抽液后注射尿激酶 10万IU +生理盐水 2 0ml,化疗方案等对照组注射生理盐水 2 0ml,化疗方案等其他治疗方法相同。结果 胸液吸收时间治疗组 2 0 .2± 3.1d ,对照组 19.6± 4 .2d(P >0 .0 5 )。抽液总量 ,治疗组 36 48± 5 12ml,对照组 2 934± 4 78ml(P <0 .0 1)。抽液次数 ,治疗组 5 .2± 1.6次 ,对照组 4 .8± 1.6次 (P >0 .0 5 )。形成纤维分隔、多房积液 ,治疗组 2例 ,对照组 9例 (P <0 .0 1)。 2月后B超查胸膜厚度 ,治疗组 1.2 2± 0 .19mm ,对照组 1.4 8± 0 .32mm(P <0 .0 1) ;肺功能FEV1% ,治疗组 89.2 %± 1.6 % ,对照组 82 .3%± 2 .1% (P <0 .0 1)。FVC %治疗组 94 .3%± 2 .2 % ,对照组 90 .2 %± 2 .4 % (P <0 .0 1)。结论 胸腔注射尿激酶能减少胸腔分隔、多房的形成。减轻胸膜增厚 。

Objective To observe the curative effect intrapleural urokinase for tuberculous pleurisy.Methods One hardred and twenty patients with tuberculous pleurisy were randomly divided into 2 groups:treatment group and control group.The patients in the treatment group were injected with urokinase 100?000IU intrapleurally each time after 1,2,3 thoracocentesis,and the patients in the control group were injected with 20ml physiological saline each time.The other therapies in both groups were the same.Results The duration of pleural effusion absorption in treatment group was (20.2±3.1) days,while it was (19.6±4.2) days in control group (P>0.05).The mean volume of fluid drained in treatment group was (3?648±512)ml,while it was (2?934±478)ml in control group (P<0.01).The mean number of fluid drained in treatment group was (5.2±1.6),while it was (4.8±1.6) in control group (P>0.05).There were two patients with pleural adhesion and loculation in treatment group,but there were 9 cases in control group (P<0.01).After two months,the mean thickness of pleura in treatment group was (1.22±0.19)mm by B ultrasonic wave test,but it was (1.48±0.32)mm in control group (P< 0.01).The lung function (FEV1%) examined was (89.2±1.6%) in treatment group,while it was (82.3±2.1%) in control group (P<0.01).FVC% was (94.3±2.2%) in treatment group,while it was 90.2±2.4% (P<0.01) in the control group.Conclusion Intrapleural urokinase can not only reduce pleural adhesion,loculation and thickening of the pleura but also improve lung function.