中心静脉导管胸腔闭式引流术与胸腔穿刺抽液术在结核性胸膜炎患者中的应用效果分析

To analyze the application effect of central venous catheter thoracic closeddrainage and thoracentesis in patients with tuberculous pleurisy

目的:对比中心静脉导管(CVC)胸腔闭式引流术(TCD)与胸腔穿刺抽液术治疗结核性胸膜炎(TBP)患者的效果。方法:回顾性选取2020年1月至2023年6月濮阳市第五人民医院60例TBP患者病例资料,按手术方案不同分为两组。以接受CVC-TCD治疗的30例患者列为A组,以接受胸腔穿刺抽液术治疗的30例患者列为B组。对比两组手术效果、围术期指标、术前、术后14 d CD4^(+)/CD8^(+)炎性因子[干扰素-γ(IFN-γ)、肿瘤坏死因子-α(TNF-α)、γ-干扰素诱导蛋白10(IP-10)]、免疫功能(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))水平、并发症发生率。结果:A组手术优良率96.67%(29/30)相较于B组73.33%(22/30)更高(P<0.05);A组胸液吸收时间、退热时间相较于B组更短,胸膜厚度、抽液总量相较于B组更低(P<0.05);A组术后14 d血清IFN-γ、TNF-α、IP-10水平相较于B组更低(P<0.05);A组术后14d CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平相较于B组更高(P<0.05);A组并发症发生率3.33%(1/30)相较于B组26.67%(8/30)更低(P<0.05)。结论:与胸腔穿刺抽液术治疗TBP患者相比,经CVC-TCD治疗可进一步提升手术效果,优化围术期指标,缓解机体炎性反应状态,提高免疫功能,降低并发症发生风险。

Objective:To compare the effect of central venous catheter(CVC)closed thoracic drainage(TCD)and thoracentesis in the treatment of patients with tuberculous pleurisy(TBP).Methods:Retrospectively collected the case data of 60 patients with TBP(January 2020 to June 2023)from the Fifth People's Hospital of Puyang,and divided them into two groups according to different surgical plans.Thirty patients treated with CVC-TCD were included in group A,and 30 patients treated with thoracentesis were included in group B.The surgical effect,perioperative indicators,inflammatory factors[interferon-γ(IFN-γ),tumor necrosis factor-α(TNF-α),interferon-inducible protein 10(IP-10)],immune function(CD3^(+),CD4^(+),CD4^(+)/CD8^(+))levels before and 14 days after operation,and the incidence of complications were compared between the two groups.Results:The excellent and good rate of group A was 96.67%(29/30),which was higher than that of group B 73.33%(22/30)(P<0.05);the pleural fluid absorption time and antipyretic time in group A were shorter than those in group B,and the pleural thickness and total amount of fluid extraction were lower than those in group B(P<0.05);the serum levels of IFN-γ,TNF-αand IP-10 in group A were lower than those in group B at 14d postoperatively(P<0.05);CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)levels were higher in group A compared to group B at 14d postoperatively(P<0.05);the incidence of complications in group A was 3.33%(1/30),which was lower than 26.67%(8/30)in group B(P<0.05).Conclusion:compared with patients with pleural puncture for the treatment of draining the TBP,CVC-TCD treatment can further improve operation effect,optimize the perioperative indicators,ease the body's inflammatory reaction condition,enhance immune function,reduce the risk of complications.