胸腔内注射尿激酶治疗结核性胸膜炎

Intrapleural injection of urokinase in the treatment of tuberculous pleurisy with effusion

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74例,随机分为治疗组与对照组各37例。治疗组第1、2、3次抽液后注射尿激酶10万IU+生理盐水20ml,对照组注射生理盐水20 ml,化疗方案等其他治疗方法相同。结果 胸腔积液吸收时间:治疗组(15. 3±6. 6)d,对照组(28. 7±9 8)d(P<0 .05)。抽液总量:治疗组(3738. 2±613. 4)ml,对照组(3114. 5±498 8)ml(P<0 .05)。抽液次数:治疗组(3.1±1 .2)次,对照组(5.7±1.8)次(P<0.05)。形成纤维分隔、多房积液:治疗组2例,对照组9例(P<0.01)。3个月后B超查胸膜厚度:治疗组(0.6±0.1)mm,对照组(1.1±0 .2)mm(P<0.05)。肺功能FEV1%:治疗组(82.6%±2.6%),对照组(75.8%±1.9%)(P<0.05);FVC%治疗组(84.2%±1.2%),对照组(77.1%±2.1%)(P<0.5)。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,改善肺功能。

Objective To observe the curative effect of intraple uralurokinase for tuberculous pleurisy.Methods Seventy-four patients with tuberculous pleurisy were randomly divided into two groups:treatment group and control group.The patients in the treatment group were injected with urokinase 100000IU 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 theapies in both groups were the same.Results The duration of pleural effusion absorption in the treatment group was (15.3±6.6) days,while it was (28.7±9.8) days in the control group(P<0.05).The mean volume of fluid drained in the treatment group was (3738.2±613.4)ml,while it was (3114.5±498.8)ml in the control group(P<0.05).The mean number of fluid drained in the treatment group was (3.1±1.2),while it was (5.7±1.8) in the control group(P<0.05).There were two patients with pleural adhesion and loculation in the treatment group,but there were 9 cases in the control group(P<0.05).After three months,the mean thickness of pleura in the treatment group was (0.6±0.1)mm by Bultrasonic wave test,but it was (1.1±0.2)mm in the control group(P<0.05).The lung function(FEV1%) examined was (82.6%±2.6%) in the treatment group,while it was (75.8%±1.9%) in the control group(P<0.01).FVC% was (84.2%±1.2%) in the treatment group,while it was (90.2±2.4%)(P<0.05) in the control group.Conclusion Intrapleural urokinase can not only reduce pleural adhesion,loculation and thickening of the pleura but also improve lung function.