中心静脉导管联合尿激酶治疗高纤维蛋白原结核性胸膜炎的疗效评价

The Therapeutic Evaluation of Central Venous Catheter Combined with Urokinase in Treatment of High Fibrinogen of Tuberculous Pleurisy

目的:观察通过中心静脉导管向胸腔注射尿激酶治疗高纤维蛋白原性结核性渗出性胸膜炎的效果。方法:选取本院2010年2月-2013年11月收治的高纤维蛋白原性结核性渗出性胸膜炎162例,按照随机数字表法分成治疗组87例和对照组75例,两组均给予全身化疗(2HREZ/4HR)及泼尼松40 mg,1次/d,治疗组在此基础上通过中心静脉导管行胸腔闭式引流和尿激酶胸腔内注射,对照组行常规胸腔穿刺抽液。观察两组胸水消退时间和并发症的发生。结果:胸水20 d后完全吸收率,治疗组73.6%(64/87),对照组为37.3%(28/75);胸膜肥厚粘连发生率,治疗组34.5%(30/87),对照组为72.0%(54/75),两组比较差异均有统计学意义(P<0.05)。结论:中心静脉导管联合尿激酶治疗高纤维蛋白原性结核性渗出性胸膜炎是一项和常规治疗方法相比更可行的技术,有较大的临床应用价值。

Objective： To explore efficacy of injection of urokinas in treatment of high lever of fibrinogen tuberculous exudative pleurisy through central venous catheter to the intrapleural. Method： One hundred and sixty-two cases of tuberculous exudative pleurisy admitted from February 2010 to November 2013 in our hospital were randomly divided into 2 groups （ 87 cases in the treatment group and 75 cases in the control group ） . The two groups were treated with systemic chemotherapy （ 2HREZ/4HR ） and prednisone 40 rag, 1 times/day, the treatment group was treated closed thoracic drainage though the central venous catheter and intrapleural urokinase injection, the control group received routine thoracic puncture and drainage. Two groups were observed the time of decreased pleura1 effusion and complications. Result： The hydrothorax absorption after 20 days was 73.6% （ 64/87 ） in the treatment group and 37.3% （ 28/75 ） in the control group, the incidence of pleural thickening and adhesion was 34.5% （ 30/87 ） in the treatment group, and 72% （ 54/75 ） in the control group, and the differences between the two groups were all statistically significant （ P〈0.05 ） . Conclusion： Venous catheter combined with urokinase conclusion centers for the treatment of high lever of fibrinogen tuberculous exudative pleurisy is more feasible than a conventional treatment method, is of great clinical value.