结核性包裹性胸腔积液治疗方法的临床研究

Observation of Effects of Intrapleural Urokinase to Treat Tuberculous Encapsulated Pleural Effusion

目的探讨尿激酶治疗结核性包裹性胸腔积液的疗效。方法 228例结核性包裹性胸腔积液患者分为治疗组与对照组,治疗组患者按病程不同分为2组:A1组(6周以内),B1组(6周以上),在正规抗结核治疗的基础上,进行抽液注药治疗,抽液后注入异烟肼0.3g、地塞米松5mg、尿激酶10万U(用生理盐水20ml稀释)共3次。对照组按病程不同分为2组:A2(6周以内),B2(6周以上),在正规抗结核治疗的基础上,进行抽液注药治疗,抽液后注入异烟肼0.3g、地塞米松5mg。结果 A1组比A2组治疗效果好,B1组比B2组治疗效果好,A1组比B1疗效果好,且所有患者均无明显不良反应。结论结核性包裹性胸腔积液,在正规抗结核治疗的基础上,可向胸腔内注入尿激酶,可以加速消除积液,减轻胸膜粘连、增厚,但宜早期(发病6周以内)用药,该疗法安全,可靠。简便易行。

Objective To study the therapeutic method for tuberculous encapsulated pleural effusion.Methods Two hundred and twenty-eight patients with tuberculous encapsulated pleural effusion were divided into treated group and control group.The treated group were divided into by course of disease：group A1（not more than six weeks）;5mg and urokinase 100000iu（resolved by physiologic saline 20 m1） intrapleurally after each thoracocentesis,total three times.The control group were divided into by the time from occurrence to being diagnosed：group A2（not more than six weeks）;group B2（more than six weeks）.On the basis of conventional anti-tuberculosis,all the patients were injected with isoniazid 0.3g,dexamehtasone 5mg intrapleurally after each thoracocentesis,total three times.Results the therapeutic effect of group A1 is the best,that of groupA2、B1 is in middle.While that of group B2 is the worst in the four groups.There are no evident adverse effects in all the patients.Conclusions For the patients with tuberculous encapsulatd epleural effusion,they Can be injected with urokianse intrapleurally on the basis of conventional anti-tuberculosis,which can promote the disappearance of the effusion,but this therapy should be executed early（not more than six weeks.This way is safe,reliable and easy.