内科胸腔镜下氩气刀联合尿激酶注入治疗在结核性包裹性胸腔积液患者中的应用效果

Application effect of argon knife combined with urokinase injection under medical thoracoscope in treatment of patients with tuberculous encapsulated pleural effusion

目的探讨内科胸腔镜下氩气刀联合尿激酶注入治疗在结核性包裹性胸腔积液患者中的应用效果。方法选取2020年4月至2021年4月到广东省高州市人民医院呼吸与危重症医学科就诊的50例结核性包裹性胸腔积液患者作为研究对象,采用随机数字法将其分为对照组(25例)和观察组(25例)。观察组接受内科胸腔镜下氩气刀联合尿激酶注入治疗,对照组接受胸腔闭式引流术置管联合尿激酶胸膜腔内注射治疗,比较两组的临床疗效、治疗指标、肺功能、并发症总发生率。结果观察组治疗总有效率高于对照组,差异有统计学意义(P<0.05)。观察组的胸腔积液消失时间、住院时间、引流天数短于对照组,胸膜厚度小于对照组,抽液总量高于对照组,差异有统计学意义(P<0.05)。两组治疗前的肺功能指标比较,差异无统计学意义(P>0.05),治疗后,两组治疗后的一秒率(FEV1/FVC)均高于治疗前,用力肺活量(FVC)均低于治疗前,且观察组的FEV1/FVC高于对照组,FVC低于对照组,差异有统计学意义(P<0.05)。两组的并发症总发生率比较,差异无统计学意义(P>0.05)。结论临床治疗结核性包裹性胸腔积液可考虑采用内科胸腔镜下氩气刀联合尿激酶注入方式,患者肺功能改善更明显,且可降低术后并发症发生率,促进病情恢复,疗效理想。

Objective To investigate the application effect of argon knife combined with urokinase injection under medical thoracoscope in treatment of patients with tuberculous encapsulated pleural effusion.Methods A total of 50 cases of patients with tuberculous encapsulated pleural effusion and who treated from April 2020 to April 2021 were selected as the research objects,and the patients were divided into control group(25 cases)and observation group(25 cases)according to the random number table method.The observation group was treated with argon knife combined with urokinase injection under medical thoracoscope,and the control group was treated with closed thoracic drainage combined with urokinase intrapleural injection.The treatment clinical effect,treatment indexes,pulmonary function and total complication rate of two groups were compared.Results The total effective rate in the observation group was higher than the control group,and the difference was statistically significant(P<0.05).The disappearance time of pleural effusion,hospitalization time and drainage days in the observation group were shorter than those in the control group,the pleural thickness was smaller than that in the control group,and the total amount of fluid extraction was higher than that in the control group,with statistical significances(P<0.05).There was no significant difference in lung function between the two groups before treatment(P>0.05).After treatment,the FEV1/FVC of the two groups after treatment was higher than that before treatment,FVC was lower than that before treatment,the FVC in the observation group was lower than that in the control group,FEV1/FVC was higher than that in the control group,the differences were statistically significant(P<0.05).There was no significant difference in the total complications rate between the two groups(P>0.05).Conclusion The clinical treatment of tuberculous encapsulated pleural effusion can consider the use of medical thoracoscopic argon knife combined with urokinase injection,the improvement of pulmonary function is more significant,and which can reduce postoperative complications,promote the recovery of the disease,the clinical effect is ideal.