莫西沙星联合胸腔置管注入尿激酶预防结核性胸腔积液胸膜肥厚粘连39例

Moxifloxacin Combined with Intrathoracic Injection of Urokinase for Preventing Pleural Thickening and Adhesions in 39 Cases of Patients with Tuberculous Pleurisy

目的观察口服莫西沙星联合胸腔置管闭式引流并注入尿激酶对非包裹性结核性胸腔积液胸膜肥厚粘连的预防作用。方法将117例中到大量非包裹性结核性胸腔积液患者随机均分为3组,对照组采用常规抗结核药+胸腔置管引流,试验组1予常规抗结核药治疗,每次引流胸腔积液后注入尿激酶,试验组2将吡嗪酰胺替换为莫西沙星口服,每次引流胸腔积液后注入尿激酶。记录胸腔积液完全吸收时间,观察不良反应发生情况,并分别于治疗前及治疗后2个月复查3组患者胸部CT观察胸膜肥厚粘连情况。结果 2个月后,与对照组相比,2个试验组胸膜肥厚程度明显减轻,胸膜粘连发生率明显减少(P<0.01),且试验组2较试验组1胸膜肥厚及粘连减轻更明显(P<0.05);试验组2胸腔积液吸收时间最短,不良反应发生率最低,与另外两组相比,差异有统计学意义(P<0.05)。结论莫西沙星联合胸腔置管闭式引流并注入尿激酶对非包裹性结核性胸腔积液有很好的预防胸膜肥厚粘连作用,且胸腔积液吸收充分,完全吸收时间短,不良反应发生率低,值得临床推广。

Objective To observe the preventive effect of moxifloxacin combined with intrathoracic injection of urokinase on pleural thickening and adhesions in patients with tuberculous pleurisy. Methods 117 patients with tuberculous pleurisy of medium to large ef- fusion were randomly divided into control group, test group 1 and test group 2. The control group was given conventional anti- tubercu- losis therapy plus pleural cavity catheter drainage. The test group 1 received intrathoracic injection of urokinase after pleural cavity catheter drainage besides the therapy in control group. In the test group 2, moxifloxacin replaced pyrazinamide while the remaining ther- apy was the same as the test group 1. The pleural effusion extinction time and the adverse reactions were recorded. The pleural thick- ening and adhesions were examined with chest CT 2 months later. Results After 2 months, compared with the control group, the pleural hypertrophy of the two test groups significantly reduced, and the incidences of pleural adhesions were also significantly reduced（P 〈 0. 01）, and compared with test group 1, the improvement in test group 2 was more significant（ P 〈 0 05）; the pleural effusion absorption time in the test group 2 was the shortest, and the incidence rate of adverse reactions was the lowest, andthe difference compared with the other 2 groups was statistically significant（ P 〈 0.05）. Conclusion Moxifloxacin combined with intrathoracic injection of urokinase can prevent pleural thickening and adhesions, shorten the pleural effusion extinction time and reduce adverse reactions, which is worthy of clinical promotion.