胸腔内注射尿激酶联合中心静脉导管引流治疗结核性胸腔积液的临床研究

Clinical study of thoracic injection of urokinase combined with central venous catheter drainage in the treatment of tuberculous pleural effusion

目的观察胸腔内注射尿激酶联合中心静脉导管引流治疗结核性胸腔积液的临床疗效。方法将我院2013年1月~2016年12月收治入院的100例结核性胸膜积液患者作为研究对象,随机分为两组,观察组50例行中心静脉导管引流联合胸腔内注射尿激酶治疗,对照组50例行常规胸腔穿刺抽液,比较两组患者的总有效率,积液消失时间、引流持续时间、引流总量、住院时间、胸膜厚度和穿刺不良事件的人均发生率。结果观察组总有效率明显大于对照组总有效率,差异具有统计学意义(P<0.05);观察组积液消失时间、引流持续时间、住院时间、胸膜厚度等指标均明显低于对照组,差异具有统计学意义(P<0.05),而观察组患者引流总量明显高于对照组,差异有统计学意义(P<0.05);两组患者胸膜反应、气胸等不良反应发生率比较差异无统计学意义(P>0.05);观察组患者胸膜粘连肥厚、包裹积液、术后胸痛、院内感染等不良事件发生率均明显高于对照组,差异有统计学意义(P<0.05)。结论中心静脉导管引流联合胸腔内注射尿激酶治疗结核性胸腔积液引流较彻底,且安全,不良反应少,可在临床推广应用。

Objective To observe the clinical effect of intra-thoracic injection of urql（inase combined with. central venous catheter drainage for tuberculous pleural effusion. Methods 100 patients with tuberculous pleural effusion cured in our hospital from January 2013 to December 2016 were randomly divided into two groups.Patients in observation group 50 cases were treated with central venous catheter drainage combined with thoracic cavity.Patients in control group 50 cases were treated with routine thoracic puncture and drainage.The total effective rate,the time of disappearance of the effusion,the duration of drainage,th.e total amount of drainage,~]）e length of hospitalization,the thickness of the pleural and the incidence of puncture of the two groups were compared. Results The total effective rate of observation group was significantly greater than that of control group,the difference was statistically significant （P 〈 0.05）.The fluid loss time,drainage duration,hospital stay,pleural thickness and （~ther indicators of observation group were significantly lower than those of control group （P 〈 0.05）.The incidence of adverse reactions was significantly higher in the two groups （P 〈 0.05）,but the difference was statistically significant （P 〈 0.05）.The incidence of adverse reactions such as pleural reaction and pneumothorax in the observation group were significantly higher than those in the control group （_P ~ 0.05）.The incidence of adverse events such as pleural adhesions,encapsulated effusion,postoperative chest pain and nosocomial infection were significantly higher in the observation group than those in the control group,and the difference was statistically sigoificant （P 〈 0.05）. Conclusion Central venous catheter drainage combined with intrapleural injection of urokinase in the treatment of tuberculous pleural effusion drainage is more thorough,safe,and it has less adverse reactions.It can be popularized in clinical application.