超声在尿激酶注射溶解结核性胸腔积液纤维分隔中的应用价值

Ultrasonic manifestations and clinical value of ?brous cord separation in pleural effusion of tuberculous pleurisy dissolved by urokinase at different time periods

目的通过超声观察尿激酶胸腔内注射对结核性胸腔积液中纤维条索分隔的溶解效果,探讨尿激酶溶解胸腔积液中纤维条索分隔的时间规律及最佳引流时间节点。方法选取临床确诊为结核性胸膜炎合并胸腔积液,且积液中有纤维条索影响引流效果的患者147例,所有患者均在超声引导下置管术引流不畅后随即注入尿激酶20万单位,根据药物注射后充分引流量将患者分为A组(充分引流量≤500 ml)48例,B组(充分引流量500～800 ml)63例,C组(充分引流量≥800 ml)36例。通过超声检查分析注药前,注药后0.5 h、1.0 h、1.5 h、2.0 h、2.5 h、3.0 h不同时间节点胸腔积液中分隔腔隙数及溶解率的变化,并进行统计分析。结果 147例患者胸腔积液纤维分隔腔隙数在药物注射不同时间节点比较,总体差异有统计学意义(F=34.989,P=0.000),其中注药前与注药后1.0 h比较,差异有统计学意义(t=6.274,P=0.000),注药后0.5 h和1.0 h比较,差异有统计学意义(t=3.300,P=0.001),注药后1.0 h与1.5 h、2.0 h、2.5 h、3.0 h分别比较,差异均无统计学意义(P均> 0.05)。A、B、C 3组注药后1.0 h与注药前、注药后0.5 h比较,差异均有统计学意义(与注药前比较:t=-6.020、-4.331、8.554,与注药后0.5 h比较:t=-3.338、2.613、5.216,P均<0.05),注药后1.0 h与1.5 h、2.0 h、2.5 h、3.0 h分别比较,差异均无统计学意义(P均> 0.05)。结论 20万单位尿激酶注射1.0 h内胸腔积液中纤维条索分隔腔隙溶解速度最快,注射1.0 h后溶解效果不明显。超声作为实时观察胸腔内纤维分隔溶解变化的一种有效方法,值得临床推广应用。

Objective To observe the effect of intrathoracic injection of urokinase on the separation of fibrous septa in the pleural effusion of patients with tuberculous pleurisy treated by ultrasound, and to explore the time rule and optimal drainage time node of fibrin strip separation in urokinase-dissolved pleural effusion. Methods A total of 147 patients with tuberculous pleurisy and pleural effusion with fiber strips influencing the drainage were selected. According to the full drainage volume on the day, 48 cases were divided into group A (fully diverted flow≤500 ml), 63 cases in group B (fully diverted flow 500~800 ml), and 36 cases in group C (fully diverted flow≥800 ml). All of them were injected with 200,000 units of urokinase. Then we analyzed the images under the guidance of ultrasound at the time points of before injection, and 0.5 h, 1.0 h, 1.5 h, 2.0 h, 2.5 h and 3.0 h after injection. The changes of the number of fibrous septa in pleural effusion at different time points were analyzed. Results After drug injection, the number of pleural effusion fibers in the 147 patients was compared at different time points, and there was a statistically difference (F=34.989, P=0.000). There was a statistical difference between before injection and 1.0 h after injection (t=6.274, P=0.000). There was a statistical difference between 0.5 h and 1.0 h after injection (t=3.300, P=0.001). There was no statistical difference between 1.0 h and 1.5 h, 2.0 h, 2.5 h, 3.0 h after injection (P>0.05). There were statistical differences between 1.0 h after injection in group A, B and C, and 0.5 h before injection and 0.5 h after injection (pre-drug comparison: t=-6.020,-4.331, 8.554;compared with 0.5 h after injection: t=-3.338, 2.613, 5.216;all P<0.05). There was no statistical difference between 1.0 h and 1.5 h, 2.0 h, 2.5 h, and 3.0 h after injection (all P>0.05). Conclusion After injection of 200,000 units of urokinase, the fastest dissolution rate of fibrous septa in pleural effusion achieved with the first hour, and the dissolution effect was not obvious at 1.5 h after injection. Ultrasound is an effective method to observe the changes of fibrous septa dissolution in thoracic cavity in real time, and is worthy of clinical application.