胸腔微创置管辅助尿激酶或链激酶注入治疗结核性胸膜炎临床评价

Clinical Evaluation of Minimally Invasive Thoracic Cavity Drainage Tube Combined with Urokinase or Streptokinase Injection in Treating Tuberculous Pleurisy

目的探讨胸腔微创置管辅助尿激酶或链激酶注入治疗结核性胸膜炎中的临床疗效。方法选择医院收治的初治的结核性胸膜炎患者90例,按随机数字表法分为胸腔置管辅助尿激酶组(UK组)、胸腔置管辅助链激酶组(SK组)和对照组(C组),各30例。C组给予常规抗结核治疗和反复胸腔穿刺抽液,UK组和SK组分别在常规抗结核治疗的基础上给予胸腔微创置管引流并辅助尿激酶(25万U)或链激酶(25万U)注入治疗。结果与C组比较,UK组和SK组患者的临床总有效率明显提高(P<0.05);UK组和SK组患者的胸穿次数、治疗后胸闷和发热时间明显缩短,残留的胸膜厚度增厚明显减少(P<0.05);3组患者治疗后肺功能指标和动脉血气分析均较本组治疗前明显改善(P<0.05);与C组比较,UK组和SK组肺功能指标和动脉血气分析结果有明显差异(P<0.05);与C组比较,UK组和SK组患者的气胸、胸膜反应、出血均明显降低(P<0.05)。结论与多次胸穿抽液比较,胸腔微创置管辅助尿激酶或链激酶注入在治疗结核性胸膜炎疗效更佳,且不良反应发生率更低。

Objective To investigate the curative effects of minimally invasive thoracic cavity drainage tube combined with urokinase or streptokinase injection in treating tuberculous pleurisy. Methods A total of 90 patients with tuberculous pleurisy were randomly divided into thoracic cavity drainage combined with urokinase group （ group UK ） , thoracic cavity drainage combined with streptokinase （ group SK ） and the control group （ group C ） , 30 cases in each group. The group C was only treated with routine anti-tuberculosis treatment and repeated thoracic puncture drainage, on this basis, the group UK and the group SK were treated with urokinase （ 25 millions IU ） or streptokinase （ 25 millions IU ） injected through thoracic cavity drainage. Results Compared with the group C, the total effective rate of the group UK and the group SK were obviously improved （ P 〈 0. 05 ） . In the UK group and the SK group, the times of thoracic puncture, the time of chest tightness and fever were significantly shortened, and the residual pleural thickness was significantly decreased （ P 〈 0. 05 ） . After treatment, the pulmonary function indexes and arterial blood gas analysis of the 3 groups were significantly improved than before treatment （ P 〈 0. 05 ） , but there was no significantly difference among the 3 groups （ P 〉 0. 05 ） . Compared with the group C, the pneumothorax, pleural reaction and bleeding in the group UK and the group SK were significantly lower （ P 〈 0. 05 ） . Conclusion Compared with repeatedly thoracentesis, injecting urinatese or streptokinase into chest by thoracic cavity drainage has better curative effect and less adverse reactions.