改良中心静脉导管序贯治疗复杂性胸腔积液的临床研究

Study of improved central venous catheter in treatment of complicated parapneumonic effusions

目的 观察改良中心静脉导管胸腔内注入尿激酶（UK）联合导丝切割及序贯胸腔冲洗的方法治疗复杂性胸腔积液的疗效。方法 102例结核性胸膜炎患者，治疗前经B超证实胸液呈多发分隔或蜂窝状。均常规予以抗痨治疗，随机分为3组：A组36例胸膜腔置入改良中心静脉导管，用J型导丝插入导管中反复抽插旋转后抽净胸水，用25万IUUK＋生理盐水100ml注入胸腔，4h抽出，并用500ml生理盐水冲洗，隔日1次，连续3次；B组32例不用生理盐水冲洗，其余同A组；C组34例用穿刺针抽液，隔日1次。3组均观察前后肺功能变化、胸膜厚度、胸液引流量、FDP量。结果 A组较B组和C组的胸液引流彻底，胸膜肥厚黏连，肺功能、症状改善明显（P〈0.05）。结论 改良中心静脉导管联合弹性导丝切割及胸腔内注入UK序贯胸腔冲洗的方法能显著增加胸液引流量，能有效降低胸膜肥厚和黏连发生的机会和程度，与对照组相比有显著性差异。

Objective To investigate the effects of transcatheter injection of urokinase （UK） and douching with normal saline and incise with guide wire in treatment of complicated parapneumonic effusions. Methods 102 patients with loculated pleural effusions were randomized into three groups, regular antituberculosis treatment was used for all patients. 36 patients were inserted the improved central venous catheter, rotating the J Tip Guide Wire again and again, subsequently exhausted the pleural fluid, injected UK 250 000 IU （diluted by 100 ml normal saline） intrapleurally and drained after 4 h, subsequently irrigated every other day with 500 ml normal saline（A group） ;32 patients were identical except to douching with 500 ml normal saline（group B）;34 patients received thoracentesis every other day （group C）. FDP, pulmonary function testing, the thickness of pleura were observed between three groups. Results The amount of pleural fluid in group A was significantly higher than that in B and C groups. The absorption time of pleural fluid and the thickness of pleura and pulmonary function testing in A group were further improved than those in B and C groups （ P 〈0.05）. Conclusions Intrapleural UK from improved central venous catheter and incise with guide wire could evidently increase the volume of pleural effusion drained and prevent pleural thickening and adhesion in control group.