中心静脉导管胸腔闭式引流联合腔内注射治疗结核性胸腔积液的临床疗效探讨

Clinical Curative Effect of Closed Thoracic Drainage Using Central Venous Catheter Combined with Intrapleural Injection in Treatment of Tuberculous Pleural Effusion

目的 探讨中心静脉导管胸腔闭式引流联合腔内注射治疗结核性胸腔积液的临床疗效。方法 筛选2014年1月—2015年1月该院收治的结核性胸膜炎患者98例,作为研究对象。采用随机数表法将其分为对照组与治疗组,其中对照组患者采取常规胸腔穿刺抽液治疗,隔日抽液1次;治疗组患者接受中心静脉导管胸腔闭式引流联合腔内注射20 U、生理盐水50 mL进行治疗,记录两组患者引流胸液容量、胸水吸收时间、胸膜增厚程度等指标并进行比较。结果引流胸液容量治疗组(1488±237)mL,对照组(1032±241)mL(t=17.355,P=0.015);胸水吸收时间治疗组(15.7±2.5)d,对照组(24.1±3.5)d(t=4.165,P=0.021);血性胸水发生率治疗组2.04%,对照组8.16%(x^2=2.024,P=0.018);差异具有统计学意义;而胸膜增厚率治疗组4.08%,对照组12.24%(x^2=2.271,P=0.134);胸膜反应发生率治疗组2.04%,对照组8.16%(x^2=2.024,P=0.181)差异无统计学意义。结论采用中心静脉导管胸腔闭式引流联合腔内注射治疗结核性胸腔积液具有较好的疗效,胸腔积液引流量较大并且胸水吸收时间较快,并发症发生率较低,具有临床应用及推广价值。

Objective To investigate the clinical efficacy of closed thoracic drainage using central venous catheter combined with intracavitary injection in the treatment of tuberculous pleural effusion.Methods 98 patients tuberculous pleurisy admitted to our hospital between January 2014 and January 2015 were selected as the research object and randomly divided into control group and treatment group.Patients in the control group took routine thoracic puncture,once every other day,while those in the treatment group were treated with closed thoracic drainage using central venous catheter and intracavitary injection of urokinase 200000 U and saline 50 ml.Indicatoers including pleural fluid drainage capacity,pleural fluid absorption time,pleural thickening degree were recorded and compared.Results Pleural fluid drainage capacity of the treatment group was（1488± 237） mL,and that of the control group was（1032±241） mL,（t=17.355,P〈0.015）;pleural fluid absorption time of the treatment group was（15.7±2.5） d,and that of the control group was（24.1±3.5） d,（t=4.165,P=0.021）;bloody pleural effusion incidence of the treatment group was 2.04%,and that of the control group was 8.16%,（χ2=2.024,P=0.018）;the differences were statistically significant;the rate of pleural thickening of the treatment group was 4.08%,and that of the control group was 12.24%,（χ2=2.271,P=0.134）;the rate of pleura reaction of the treatment group was 2.04%,and that of the control group was 8.16%,（χ2=2.024,P=0.181）,and the difference was not statistically significant.Conclusion Using thoracic closed drainage of the central vein catheter combined with intracavitary injection in the treatment oftuberculous pleural effusion has good curative effect,pleural effusion andpleural effusion drainage volume larger absorption time faster,low incidence of complications,clinical value.