超声引导下猪尾巴管置管引流联合胸腔镜对老年结核性胸腔积液患者的治疗效果

Therapeutic effects of thoracoscopic ultrasound-guided pigtail drainage for tuberculous pleural effusion in elderly patients

目的探讨老年结核性胸腔积液患者经超声引导下猪尾巴管置管引流联合胸腔镜的治疗效果.方法选取2018年4月至2020年5月于郑州市第六人民医院接受治疗的老年结核性胸腔积液患者100例,采用数字奇偶法将分为研究组(奇数)与传统组(偶数),各50例;所有患者均接受超声引导经胸腔镜吸净胸腔积液,传统组采用传统胸腔引流管置管引流,研究组采用猪尾巴管置管引流,均引流至患者拔管后停止,分别于置管前及拔管后检测并比较两组外周血程序性死亡因子-1(PD-1)、程序性死亡配体-1(PD-L1)及PD-1/PD-L1水平,记录两组患者临床指标(引流量、引流管留置时间、住院时间)以及留置引流管期间并发症的发生情况.结果两组患者拔管后外周血PD-1、PD-L1及PD-1/PD-L1水平均较置管前降低,且研究组的(31.95±10.41)ng/L、(26.14±1.03)ng/L、(1.22±0.12)ng/L,低于传统组的(43.31±12.03)ng/L、(30.62±1.57)ng/L、(1.41±0.63)ng/L(t=5.049、16.871、2.095,P<0.001、0.039);研究组引流管留置时间(7.36±2.95)d及住院时间(15.43±3.12)d,均短于传统组(11.32±3.87)d、(22.15±6.98)d(t=5.754、6.215,均P<0.001),而两组患者拔管后引流量的差异无统计学意义(P>0.05);研究组引流管脱出及引流管阻塞的发生率均低于传统组[2.00%(1/50)比16.00%(8/50)、0.00%(0/50)比18.00%(9/50)](χ^(2)=4.396、7.814,P=0.036、0.005),而两组患者纵隔摆动、皮下气肿、胸腔内感染及血胸的发生率差异无统计学意义(均P>0.05).结论老年结核性胸腔积液患者经超声引导下猪尾巴管置管引流联合胸腔镜的治疗效果显著,利于降低患者外周血PD-1/PD-L1水平、缩短引流管留置时间、减少部分并发症的发生.

Objective To investigate the therapeutic effects of ultrasound-guided pigtail drainage under thoracoscopy in elderly patients with tuberculous pleural effusion.Methods Elderly patients with tuberculous pleural effusion treated at Zhengzhou Sixth People's Hospital between April 2018 and May 2020 were selected.With a method using odd and even numbers,100 elderly patients with tuberculous pleural effusion were randomly divided into a study group(odd numbers)and a conventional treatment group(even numbers)»with 50 cases in each group.All patients received ultrasound-guided thoracoscopy lo remove pleural effusion.The conventional treatment group received regular thoracic drainage catheters and the study group received pigtail catheters for drainage.Drainage was stopped after the patient was extubated.The levels of programmed cell death 1(PD-1),programmed death-ligand 1(PD-Ll)and PD-1/PD-L1 in peripheral blood were detected and compared before and after catheterization;Values of clinical indicators including drainage volume,catheter retention time Jength of hospitalization and complications during catheter drainage for the two groups were recorded.Results After extubation,the levels of PD-1,PD-Ll and PO-1/PD-L1 in peripheral blood for both groups decreased,compared with pre-catheterization levels,with the study group having lower levels[(31.95±10.41)ng/L,(26.14±1.03)ng/L.(1.22±0.12)ng/L]than the conventional treatment group[(43.31±12.03)ng/L,(30.62±1.57)ng/L,(1.41±0.63)ng/L](1=5.049.16.871,2.095,P<0.001,0.039).The study group had a catheter retention time of(15.43±3.12)d and a length of hospitalization of(7.36±2.95)d,shorter than(11.32±3.87)d and(22.15±6.98)d in the conventional treatment group(1=5.754,6.215,both P<0.001),but there was no statistical significant difference in drainage volume between the two groups(P>0.05).The incidence of drainage catheter falling out and catheter obstruction in the study group was lower than in the conventional treatment group[2.00%(1/50)vs.16.00%(8/50).0.00%(0/50)vs.18.00%(9/50)](X^(2)=4.3967.814,P=0.036,0.005),and there was no statistical significant difference in the incidence of mediastinal shifting,subeutaneous emphysema,intrathoracic infections or hemothora x between the two groups(all P>0.05).Conelusions Thoracoscopic ultrasound-guided pigtail catheter drainage for the treatment of elderly patients with tuberculous pleural effusion is clearly effective and may help to reduce the level of PD-1/PD-Ll in peripheral blood,shorten the time of eatheter drainage and deerease some complications for patients.