新方法初治结核性胸膜炎的疗效观察

Efficacy of a new therapeutic approach as initial treatment for tuberculous pleuritis

目的探讨左氧氟沙星联合抗结核药物及胸腔置管治疗结核性胸膜炎的疗效观察。方法选择汉中市中心医院及安康市中心医院感染科2014年2月—2016年8月收治的初治结核性胸膜炎患者,分为A、B、C、D组。A组治疗方案为2HRZE+7HR,并行常规抽液;B组治疗方案为2HRZE+7HR,并行胸腔置管;C组治疗方案为2HRZEV+7HR,并行胸腔置管;D组治疗方案为2HRZEV+10HR,并行胸腔置管。B、C、D组患者行胸腔置管,经引流管注入生理盐水20 mL加尿激酶10万单位。结果共收治初治结核性胸膜炎患者172例。A组45例,B组53例,C组38例,D组36例。A组患者胸腔积液治疗总有效率(64.44%)低于B组(90.57%),差异有统计学意义(χ~2=9.863,P<0.05);B、C两组治疗2个月后进行临床疗效的对比,B组总有效率(18.87%)低于C组(39.47%),差异有统计学意义(χ~2=4.716,P<0.05);C、D组在治疗结束后进行临床疗效的对比,C组总有效率(60.53%)低于D组(83.33%),差异有统计学意义(χ~2=4.731,P<0.05)。结论对于初治的结核性胸膜炎患者给予2HRZEV+10HR抗结核方案及胸腔置管并注入尿激酶,此种治疗方案能改善患者的临床症状,提高结核性胸膜炎的治愈率,促进胸腔积液的排出,防止胸膜肥厚、黏连及包裹。

ObjectiveTo explore the therapeutic efficacy of levofloxacin combined with anti tuberculosis drugs and thoracic catheterization for the treatment of tuberculous pleuritis.MethodsPatients who were admitted to Departments of Infectious Diseases of Hanzhong Central Hospital and Ankang Central Hospital between February2014and August2016for initial treatment of tuberculous pleuritis were included in the study,they were divided into groups A,B,C and D.Group A received2HRZE+7HR regimen combined with conventional drainage;group B received2HRZE+7HR regimen combined with thoracic catheterization;group C received2HRZEV+7HR regimen combined with thoracic catheterization;group D received2HRZEV+10HR regimen combined with thoracic catheterization.groups B,C and D received thoracic catheterization,normal saline20mL and urokinase100,000U were given through the drainage tube.ResultsA total of172patients with newly diagnosed tuberculous pleurisy were received for treatment.There were45,53,38,and36cases in group A,B,C,and D respectively.The total effective rate of therapy for pleural effusion in group A was lower than that in group B(64.44%vs90.57%,χ2=9.863,P<0.05);after two month therapy,total effective rate of therapy for pleural effusion in group B was lower than that in group C(18.87%vs39.47%,χ2=4.716,P<0.05);at the end of therapy,total effective rate in group C was lower than that in group D(60.53%vs83.33%,χ2=4.731,P<0.05).ConclusionFor initial treatment of patients with tuberculous pleuritis,2HRZEV+10HR antituberculosis regimen combined with thoracic catheterization and urokinase infusion can significantly improve the clinical symptoms and recovery rate of tuberculous pleuritis,facilitate drainage of pleural effusion and prevent pleural thickening,adhesion and encapsulation.