艾贝尔中心静脉导管引流与间断胸穿抽液治疗恶性胸腔积液的临床研究

Clinical Analysis of Inserting Abel Central Venous Catheter into Pleural Cavity and Interrupted Pleural Cavity Puncture to Draw Pleural Effusion in the Treatment of Patients with Malignant Pleural Effusion

目的比较艾贝尔中心静脉导管与间断胸穿抽液治疗恶性胸腔积液的临床疗效及安全性。方法分析2009年3月～2012年6月在笔者医院呼吸内科病房收治104例确诊为恶性胸腔积液患者的临床资料。根据信封抽签随机入组,其中52例患者应用艾贝尔中心静脉导管置管闭式引流加药物榄香烯乳针灌注治疗(艾贝尔管引流组,A组),另外52例患者应用间断胸腔穿刺抽液加药物榄香烯乳针灌注治疗(胸腔穿刺抽液组,B组),比较两者的临床疗效、不良反应、住院时间等方面差异。结果艾贝尔中心静脉导管置管引流组(A组)与间断胸腔穿刺抽液组(B组)比较,完全缓解14例(27%)vs 0例(0%),部分缓解21例(40%)vs 6例(12%),轻微缓解10例(19%)vs 20例(38%),临床无效7例(13%)vs 26例(50%),疗效比较P<0.01,两组具有极显著性差异;操作后出现胸痛者分别为21例(40%)vs 8例(15%);肺复张性呼吸困难8例(15%)vs 18例(35%);发生损伤性气胸为2例(4%)vs 8例(15%),两组不良反应比较P<0.05,具有显著性差异;住院时间为10.0±3.3天vs 17.5±3.6天,P<0.01,具有极显著性差异。结论艾贝尔中心静脉导管置管引流加药物灌注治疗与间断胸穿抽液加药物灌注比较,前者具有操作简便易行,临床疗效显著,不良反应方面胸痛较多,但肺复张性呼吸困难、损伤性气胸较少,住院时间明显缩短,是治疗恶性胸腔积液行之有效的治疗方法,值得临床推广应用。

Objective To compare the clinical therapeutic effects and safety of Abel central venous catheter with interrupted pleural cavity puncture in the treatment of malignant pleural effusion. Methods Totally 104 patients with malignant pleural effusions were ran- domly divided into experimental group （n = 52）and control group （n = 52 ） by envelope in our hospital from March 2009 to June 2012. Pa- tients in the two groups were treated with inserting Abel central venous catheter and interrupted pleural cavity puncture to draw pleural ef- fusion respectively. The effectiveness, complication and hospital stay in two groups were compared. Results After treatment, 14 （27%） cases in experimental group gained complete remission vs 0 （0%）cases in control group, 21 （40%）cases gained partial remission vs 6 （12%） cases, 10 （19%） cases gained minor response vs 20（38% ）cases, 7 （13%）cases with no change vs 26 （50%）cases. The total effective rate of the experimental group was obviously higher than that of the control group. The chest pain incidence in experimental group and control group were 40% and 15%, respectively; the dyspnea after operation were 15 % and 35% , respectively; the pneumothorax inci- dence were 4% and 15 % , respectively ; the average time of hospital stay in experimental group and control group were 10.0 ± 3.3 days and 17.5±3.6 days, respectively. All indexes showed significant difference between the two groups （ P 〈 0.05 ）. Conclusion The method by inserting Abel central venous catheter to treat malignant pleural effusion has the advantages of reliable curative effects and little complica- tion and it can shorten hospital stay. It is worthwhile to popularize and apply this treatment method.