肺炎及肺癌伴胸腔积液患者的急救疗效研究

Emergency Efficacy of Pneumonia and Lung Cancer Patients with Pleural Effusion

目的探讨抗炎和强心利尿对胸腔积液患者的治疗效果及治疗前后血浆B型钠尿肽(BNP)和C-反应蛋白(CRP)浓度的变化。方法将2012年6月至2013年8月急诊住院治疗的62例胸腔积液患者分为2组:肺炎胸腔积液患者(肺炎组)31例和肺癌胸腔积液患者(肺癌组)31例。2组患者在治疗原则上都是采用抗感染与强心、利尿和限制液体出入量。所有患者分别于治疗前和治疗后1周进行胸部CT扫描,同时检测患者的血浆BNP、PCT浓度。结果治疗前肺炎组血浆BNP(581.75±125.50)ng/L明显高于肺癌组(145.72±42.56)ng/L,差异有统计学意义,P<0.01;与治疗前比较,肺炎组治疗后血浆BNP(224.62±131.33)ng/L明显降低(P<0.05),而肺癌组(149.43±51.10)ng/L无明显变化。肺炎组胸腔积液疗效明显优于肺癌组。治疗前肺炎组血浆PCT明显低于肺癌组(P均<0.05),治疗后2组患者PCT下降到或接近正常生理范围,组间比较差异无统计学意义。结论血浆BNP和PCT浓度的变化对于胸腔积液者心功能不全的筛查和强心、抗炎治疗效果的评估有重要的临床意义。

Objective To observe the therapeutic effect of anti-inflammatory combined with cedilanid and diuretic thera-py for patients with senile pneumonia and lung cancer accompanied by pleural effusion ,and to investigate the changes of concen-trations in plasma levels of B-type natriuretic peptide(BNP)and C-reactive protein(CRP)before and after treatment.Methods 62 emergently hospitalized patients with pleural effusion were divided into 2 groups:senile pneumonia group(31 cases)and lung cancer group(31 cases).The same therapeutic measures were taken in the 2 groups,such as anti-infection,enhancement of cardi-ac function,diuresis,and limitation of the amount of liquid intake .Respectively,all the patients took the CT scan of the chest be-fore treatment and on the 7th day after treatment,and at the same time,plasma concentrations of BNP,PCT were detected.Results Before treatment,the plasma BNP level in pneumonia group was obviously higher than that of the lung cancer group (ng/L:581.75 ±125.50 vs.145.72 ±42.56,P<0.01);compared with that before treatment ,BNP was significantly decreased in the pneumonia group (ng/L:224.62 ±131.33,P<0.05)after treatment,but no such obvious change in the lung cancer group (ng/L:149.43 ± 51.10)was seen.The therapeutic effect of pleural effusion in the pneumonia group was markedly better than that in lung cancer group.Before treatment,the plasma levels of CRP in pneumonia group were remarkably lower than those in lung cancer group (P<0.05);after treatment,PCT levels were decreased or decreased to close to the normal physiological range in patients of the 2 groups.Conclusion Concentration changes of plasma BNP and PCT has important clinical significance in screening the cardiac insufficiency and evaluating the curative effect of anti-inflammatory combined with cedilanid and diuretic therapy in patients of lung diseases complicated by pleural effusion .