经中心静脉导管引流联合胸腔注射药物治疗结核性胸膜炎的临床观察

Clinical study on central venous catheter drainage and intrapleural injection of urokinase in the treatment of tuberculous pleurisy

目的 探讨经中心静脉导管引流联合尿激酶、地塞米松、异烟肼等药物胸腔注射对结核性胸膜炎预后的影响.方法 选取结核性胸膜炎患者60例,采用简单随机分组方法分为观察组（n=30）和对照组（n=30）.两组均给予3HRZE/6HR方案抗结核治疗,观察组行中心静脉导管引流并给予尿激酶、地塞米松、异烟肼等药物胸腔注射;对照组仅给予胸腔穿刺抽液术.观察两组临床疗效、胸水完全消退时间、有无胸膜增厚、住院天数、住院费用及气胸等不良反应发生率.结果 观察组治疗1周时有效率46.7％,明显高于对照组（20.0％）,两组差异有统计学意义（x2 =4.800,P=0.028）;观察组胸水完全消退时间（20.5±6.7）d,显著短于对照组的（25.1±7.7）d,两组差异有统计学意义（t =2.484,P=0.016）;观察组胸膜增厚发生率26.7％,低于对照组的46.7％,两组差异有统计学意义（=4.444,P=0.035）;观察组不良反应发生率3.3％,低于对照组的20.0％,两组差异有统计学意义（x2=4.043,P=0.044）;观察组住院时间（9.4±2.7）d,对照组住院时间（10.3±2.8）d,两组差异无统计学意义（t=1.270,P=0.209）;观察组住院费用（6 675.4±1 818.4）元,对照组住院费用（7 508.9±1 692.1）元,两组差异无统计学意义（t=1.838,P=0.071）.结论 中心静脉导管引流联合尿激酶等药物胸腔注射治疗结核性胸膜炎的疗效明显优于传统的胸腔穿刺抽液术,值得在基层医院临床推广.

Objective To observe the therapeutic effect of central venous catheter drainage and intrapleural injection of urokinase on tuberculous pleurisy patients.Methods 60 hospitalized patients with tuberculous pleurisy were selected,and they were divided into two groupsby simple random grouping method.Both two groups received 3HRZE/6HR anti-tuberculosis treatment.30 patients in the observation group were treated with central venous catheter drainage and intrapleural injection of urokinase.30 patients in the control group were treated with conventional pleurocentesis.The duration of pleural effussion drainage,incidence of pleural thickening,hospitalization time and expense,and the adverse reaction rate were observed during treatment.Results In the observation group,the curative effect at 1 week was 46.7％,the duration of pleural effussion drainage was （20.5 ± 6.7）days,the incidence rate of pleural thickening was 26.7％,the hospitalization time was （9.4 ± 2.7） days,the hospitalization expense was （6 675.4 ± 1 818.4） RMB,the incidence rate of adverse reaction was 3.3％.In the control group,the curative effect at 1 week was 20.0％,the duration of pleural effussion drainage was （25.1 ± 7.7） days,the incidence rate of pleural thickening was 46.7％,the hospitalization time was （10.3 ± 2.8）days,the hospitalization expense was （7 508.9 ± 1 692.1） RMB,the incidence rate of adverse reaction was 20..0％.There were statistically significant differences between the two groups in the curative effect at 1 week （x2 =4.800,P =0.028）,duration of pleural effussion drainage （t =2.484,P =0.016）,incidence of pleural thickening （t =4.444,P =0.035） and incidence rate of adverse reaction （x2 =4.043,P =0.044）.No statistically significant differences were observed between the two groups in hospitalization time（t =1.270,P =0.209） and expense （t =1.838,P =0.071）.Conclusion In comparison to conventional pleurocentesis,the treatment of central venous catheter drainage and intrapleural injection of urokinase for tuberculous pleurisy is markedly efective,it is safe and Worthy of popularizing in clinical application.