中心静脉导管置管引流治疗危重患者胸腔积液的效果及安全性观察

The effect and safety of thoracic drainage by central venous catheter in critical patients with pleural effusion

目的探讨中心静脉导管置管引流治疗危重患者胸腔积液的效果及安全性。方法采用前瞻性研究方法，将2010年9月至2011年10月本院重症医学科46例有胸腔积液危重患者，根据原发病类别配对分成传统胸腔闭式引流组（对照组）和中心静脉导管置管引流组（观察组）两组进行胸腔引流，每组23例。比较两组患者引流效果和并发症；术前及术后24 h检测急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、胸腔积液定量、白细胞计数（WBC）、血小板计数（PLT）、凝血酶原时间（PT）、降钙素原（PCT）和C-反应蛋白（CRP）等指标。结果两组患者胸腔积液引流量、置管治疗时间比较差异均无统计学意义，两组治疗前后APACHEⅡ评分、胸腔积液定量、WBC、PLT、PT、PCT比较差异也均无统计意义（均P＞0.05）；观察组术后CRP水平（μg/L）较对照组明显降低（77.26±67.20比106.13±66.23，P＜0.01）。对照组并发症发生率虽高于观察组（26.1%比4.3%），但差异无统计学意义（P＞0.05）。结论采用中心静脉导管置管引流治疗危重患者胸腔积液的疗效与传统治疗相当，术后患者应激较轻且并发症较少，是一种可以替代传统胸腔闭式引流术安全、有效的治疗胸腔积液的方法。

Objective To investigate the effect and safety of thoracic drainage by central venous catheter in critical patients with pleural effusion. Methods A prospective study was carried out,in which 46 critical patients with pleural effusion admitted to department of critical care medicine were included,and according to the types of their primary diseases to make matched pairs,and they were divided into two groups：conventional drainage control group and central venous catheter drainage observation group（each 23 cases）. The drainage effect and complications were compared between the two groups,acute physiology and chronic health evaluation Ⅱ（APACHEⅡ）score, quantitative pleural effusion and the counts of white blood cells（WBC）and of platelets（PLT）,the levels of prothrombin time（PT）,procalcitonin（PCT）and C-reactive protein（CRP）,etc. were measured on the baseline and 24 hours after the operation. Results There were no significant differences in the APACHEⅡ score,quantitative pleural effusion,amount and duration of drainage,as well as the levels of WBC,PLT,PT and PCT between group control and observation（all P〉0.05）. The post-drainage CRP（μg/L）level in group observation was much lower than that in group control（77.26±67.20 vs. 106.13±66.23,P0.05）. Conclusions In the comparison between the conventional drainage and thoracic drainage with central venous catheter,the therapeutic effects for treatment of critical patients with pleural effusion were similar, but the stress was milder and the incidence of complications was lower in the latter group. Therefore,the thoracic drainage with central venous catheter is a safe,effective and alternative method to substitute the conventional drainage for critical patients with pleural effusion.