B超引导下胸膜腔内注入尿激酶治疗结核性包裹性胸膜腔积液临床观察

Observation of parcel tuberculous pleural effusion treated by B ultrasound-guided intrapleural urokinase

目的探讨在B超引导下行胸膜腔穿刺抽吸胸水并注入尿激酶治疗结核性包裹性胸膜腔积液的临床应用价值。方法将2008年9月至2010年9月我院收治的327例结核性包裹性胸膜积液患者分为两组,其中治疗组143例,男84例、女59例,平均年龄40岁,平均病程31天;对照组184例,男101例、女83例,平均年龄45岁,平均病程33天,两组均予常规强化抗结核、对症支持等综合治疗措施,并在B超引导定位下行胸膜腔穿刺抽吸胸水,治疗组在抽吸胸水后注入尿激酶治疗;观察两组患者胸水吸收情况和胸膜厚度变化情况,比较两组治疗效果。结果治疗组的胸水引流量显著高于对照组,而胸膜厚度显著低于对照组,差异均有统计学意义(P<0.01);而且治疗组总有效率达92.3%,显著高于对照组75.5%的总有效率,差异有统计学意义(P<0.01)。结论在B超引导定位下行胸膜腔穿刺抽吸胸水并注入尿激酶治疗结核性包裹性胸膜腔积液临床效果好,是一种治疗结核性包裹性胸膜腔积液安全、方便、有效、经济的方法。

Objective To investigate the clinical value of B ultrasound-guided needle aspiration of the pleural effusion and intrapleural urokinase in the treatment of the parcel tuberculous pleural effusion. Methods 327 cases of parcel tuberculous pleural effusion were divided into two groups from September 2008 to September 2010. 143 cases were in the treatment group including 84 males and 59 females, mean age was 40 years,mean disease duration was 31 days; 184 cases were in control group including 101 males, 83 females, mean age was 45 years, mean disease duration was 33 days. All cases in the two groups were treated by strengthen the conventional anti-tuberculosis, symptomatic and supportive of comprehensive treatment measures,and B ultrasound-guided pleural fluid aspiration,urokinase were injected in treatment group after aspiration of pleural effusion;pleural effusion absorption and pleural thickness variation were observed in the two groups. Results In the treatment group, pleural fluid drainage volume was higher,and pleural thickness was lower than those in the control group, differences were statistically significant（P 〈0. 01） ;and the total effective rate of 92. 3% was higher than 75.5% in the control group,the difference was statistically significant （P〈0. 01）. Conclusion The B ultrasound-guided needle aspiration of the pleural effusion and intrapleural urokinase in the treatment of the parcel tuberculous pleural effusion is a safe, convenient, effective, economic method.