加味葶苈大枣泻肺汤联合尿激酶治疗包裹性结核性胸膜炎的效果

Effects of Jiawei Tingli Dazao Xiefei Decoction combined with Urokinase in the treatment of encapsulated tuberculous pleurisy

目的观察加味葶苈大枣泻肺汤联合尿激酶治疗包裹性结核性胸膜炎的效果。方法选取2018年8月~2019年6月新疆维吾尔自治区喀什地区莎车县人民医院感染病科包裹性结核性胸膜炎患者46例,根据随机数字表法分为治疗组(23例)与对照组(23例)。对照组给予胸腔引流并尿激酶胸腔注射及基于标准化抗痨方案的2HRZE/7HRE抗结核治疗,治疗组在此基础上给予加味葶苈大枣泻肺汤治疗。疗程均为1周,后继续规范抗结核治疗。疗程结束后观察两组患者的胸腔积液消失时间、胸膜厚度、B超积液深度、住院天数以及患者的中医证候积分。结果治疗后,治疗组积液消失时间短于对照组,差异有统计学意义(P<0.05);治疗组B超测量积液深度显著低于对照组,差异有高度统计学意义(P<0.01);治疗组胸膜厚度显著低于对照组,差异有高度统计学意义(P<0.01);治疗组住院天数短于对照组,差异有统计学意义(P<0.05)。两组治疗后各项中医症候积分均低于治疗前,且治疗组发热、咳嗽、咳痰、胸胁痛积分均低于对照组,差异均有统计学意义(均P<0.05),咯血、呼吸急促积分比较,差异无统计学意义(P>0.05);两组患者均未出现明显出血、疼痛、瘙痒等不良反应情况。结论加味葶苈大枣泻肺汤能提高患者的胸腔积液吸收情况,改善胸膜增厚程度,缩短住院天数及改善中医症候,具有提高临床疗效的作用。

Objective To observe the effect of modified Jiawei Tingli Dazao Xiefei Decoction combined with Urokinase in the treatment of wrapped tuberculous pleurisy.Methods A total of 46 patients with encapsulated tuberculous pleurisy in the Department of Infectious Diseases,Xinjiang Shache People′s Hospital,Xinjiang Uygur Autonomous Region from August 2018 to June 2019 were selected.According to the random number table method,they were divided into the treatment group(32 cases)and the control group(23 cases).The control group received chest drainage and Urokinase injection and 2HRZE/7HRE antituberculosis treatment based on a standardized antituberculosis regimen,and on this basis,the treatment group was treated with Jiawei Tingli Dazao Xiefei Decoction.The course of treatment was 1 week,followed by standard anti-tuberculosis treatment.After the course of treatment,the disappearance time of pleural effusion,pleural thickness,B-ultrasonic effusion depth,length of hospital stay and traditional Chinese medicine syndrome score of the two groups were observed.Results After treatment,the effusion disappearance time in the treatment group was shorter than that in the control group,and the difference was statistically significant(P<0.05);the depth of effusion measured by B-ultrasound in the treatment group was significantly lower than that in the control group,and the difference was highly statistically significant(P<0.01);The pleural thickness of the treatment group was significantly lower than that of the control group,and the difference was highly statistically significant(P<0.01);the length of hospital stay in the treatment group was shorterer than that of the control group,and the difference was statistically significant(P<0.05).The scores of various traditional Chinese medicine symptoms in the two groups were lower after treatment than before treatment,and the scores of fever,cough,sputum and chest pain in the treatment group were lower than those in the control group,with statistically significant differences(all P<0.05).There was no significant difference in the scores of hemoptysis and shortness of breath between the two groups after treatment(P>0.05).Patients of the two groups had not obvious bleeding,pain,itching and other adverse reactions.Conclusion Jiawei Tingli Dazao Xiefei Decoction can improve the absorption of pleural effusion,improve the degree of pleural thickening,shorten the length of hospital stay and improve the symptoms of traditional Chinese medicine.