经胸壁超声导入三联药品辅助治疗结核性胸膜炎的临床价值

Clinical value of triple-drug adjuvant therapy for tuberculous pleurisy via chest wall ultrasound

目的探讨经胸壁超声导入三联药品辅助治疗结核性胸膜炎(tuberculous pleurisy,TBP)的临床价值。方法搜集海南省人民医院自2016年1月至2018年12月收治的符合入组条件的结核性胸膜炎患者76例,按入院顺序,采用随机数字表法分为观察组与对照组,每组38例。两组均给予2H-R-Z-E/10 H-R全身化疗+胸腔穿刺抽液术治疗,在此基础上,观察组辅以经胸壁超声导入异烟肼+利福平+尿激酶三联药品治疗,对照组则给予异烟肼+利福平+尿激酶三联药品单纯贴于胸壁皮肤上治疗。比较两组患者的治疗疗效,计数资料以"x±s"表示,采用t检验;计量资料以"率(%)"表示,采用χ^2检验,均以P<0.05为差异有统计学意义。结果观察组与对照组患者治疗总有效率分别为94.74%(36/38)和78.95%(30/38),差异有统计学意义(χ^2=4.146,P=0.042)。观察组与对照组患者壁层胸膜厚度在治疗2个月时分别为(5.29±0.21)mm和(5.98±0.25)mm;治疗6个月时分别为(3.25±0.39)mm和(3.75±0.41)mm;疗程结束后6个月时分别为(2.15±0.25)mm和(2.62±0.34)mm,差异均有统计学意义(t值分别为13.028、29.669和47.132,P值分别为0.000、0.000和0.000)。观察组和对照组患者胸腔积液完全吸收例数的比率在治疗6个月时分别为65.79%(25/38)和42.11%(16/38);疗程结束6个月时分别为94.74%(36/38)和78.95%(30/38),差异均有统计学意义(χ^2值分别为4.290、4.146,P值分别为0.038、0.042)。观察组和对照组用力肺活量(forced vital capacity,FVC)比较,治疗2个月时分别为(3.86±0.68)L和(3.51±0.61)L;治疗6个月时分别为(4.28±0.90)L和(3.74±0.84)L;疗程结束6个月时分别为(4.68±0.75)L和(3.98±0.79)L;两组比较,差异有统计学意义(t值分别为5.578、4.894、35.307,P值分别为0.021、0.000、0.000)。观察组和对照组1s用力呼气量(FEV1)比较,在治疗2个月时分别为(3.54±0.67)L和(3.38±0.69)L;治疗6个月时分别为(3.89±0.72)L和(3.38±0.69)L;疗程结束6个月时分别为(4.23±0.75)L和(3.54±0.71)L;两组比较,差异均有统计学意义(t值分别为4.541、3.153、16.962,P值分别为0.036、0.000、0.000)。观察组和对照组深吸气量(inspiratory capacity,IC)比较,治疗6个月时分别为(2.76±0.42)L和(2.30±0.38)L;疗程结束6个月时分别为(2.98±0.45)L和(2.49±0.43)L;两组比较,差异均有统计学意义(t值分别为5.007、23.551,P值分别为0.000、0.000)。结论经胸壁超声导入异烟肼+利福平+尿激酶三联药品治疗可进一步提升结核性胸膜炎的临床疗效,明显减轻胸膜厚度,加快胸腔积液吸收,改善肺功能。

Objective To explore the clinical value of triple-drug adjuvant therapy for tuberculous pleurisy(TBP)via chest wall ultrasound.Methods A total of 76 eligible TBP patients admitted to Hainan General Hospital from January 2016 to December 2018 were collected and randomly divided into the observation group and the control group according to the order of admission,with 38 cases in each group.Both groups were treated with2 H-R-Z-E/10 H-R systemic chemotherapy+thoracentesis and drainage.On this basis,the observation group was supplemented with a triple-drug treatment of isoniazid+rifampicin+urokinase via transthoracic ultrasound,and the control group was given the same triple-drug treatment applied to the skin of the chest wall.The therapeutic efficacy of patients was compared between the two groups.The count data were represented by x±s and analyzed using t test;and the measurement data were represented by rate(%)and analyzed usingχ^2 test.P<0.05 was considered statistically significant.Results The total effective rates of the observation and the control groups were 94.74%(36/38)and 78.95%(30/38),respectively,with the statistically significant difference(χ^2=4.146,P=0.042).The thickness of the parietal pleura in the observation and the control groups was(5.29±0.21)mm and(5.98±0.25)mm at 2 months of treatment,respectively;(3.25±0.39)mm and(3.75±0.41)mm at 6 months of treatment,respectively;and(2.15±0.25)mm and(2.62±0.34)mm at 6 months after treatment,respectively;with the statistically significant differences(t=13.028,29.669 and 47.132,P=0.000,0.000,and 0.000,respectively).The ratios of the complete absorption of pleural effusion in the observation and the control groups were 65.79%(25/38)and 42.11%(16/38)at 6 months of treatment,respectively;and 94.74%(36/38)and 78.95%(30/38)at the end of 6 months,with the statistically significant differences(χ^2=4.290 and 4.146,P=0.038 and 0.042,respectively).The forced vital capacity(FVC)of the observation group and the control group was(3.86±0.68)L and(3.51±0.61)L at 2 months of treatment;(4.28±0.90)L and(3.74±0.84)L at 6 months of treatment;and(4.68±0.75)L and(3.98±0.79)L at the end of 6 months of treatment,respectively;with the statistically significant difference between the two groups(t=5.578,4.894,and 35.307,P=0.021,0.000,and 0.000,respectively).The 1 s forced expiratory volumes(FEV1)of the observation group and the control group were(3.54±0.67)L and(3.38±0.69)L at 2 months of treatment,respectively;(3.89±0.72)L and(3.38±0.69)L at 6 months of treatment,respectively;(4.23±0.75)L and(3.54±0.71)L at the end of 6 months of treatment,respectively,with the statistically significant difference(t=4.541,3.153,16.962,P=0.036,0.000,0.000,respectively).The inspiratory capacity(IC)of the observation group and the control group was(2.76±0.42)L and(2.30±0.38)L at 6 months of treatment,respectively;(2.98±0.45)L and(2.49±0.43)L at the end of 6 months of treatment,respectively;with the statistically significant difference(t=5.007 and 23.551,P=0.000 and 0.000,respectively).Conclusion The triple-drug treatment of isoniazid+rifampicin+urokinase via chest wall ultrasound can further improve the clinical efficacy of tuberculous pleurisy,significantly reduce the thickness of the pleura,accelerate the absorption of pleural effusion and improve lung function.