尿激酶、氟美松预防结核性胸膜炎胸膜肥厚和包裹性积液

Effects of Urokinase and Corticosteroids in the Prevention of Pleural Thickening and Loculated Effusions by Tuberculous Pleurisy

目的 探讨胸膜腔内注入尿激酶、氟美松对结核性渗出性胸膜炎所致胸膜肥厚和包裹性积液的影响。方法 6 7例结核性粘连包裹性胸膜炎患者随机分为尿激酶组 (36例 )和氟美松组 (31例 )。尿激酶组于每次抽液后注入尿激酶 10 0 0 0 0 IU ,氟美松组于每次抽液后注入氟美松 5 mg。结果 尿激酶组抽液总量 (310 9± 4 39) ml,而氟美松组 (2 80 5± 4 30 ) m l(P<0 .0 1) ;尿激酶组胸膜厚度 (0 .81± 0 .2 3) mm,而氟美松组 (1.12± 0 .2 4 ) mm(P<0 .0 1) ;尿激酶组胸膜粘连的发生率为 11% ,而氟美松组为 39% (P<0 .0 1)。结论 胸腔内注入氟美松虽能减少胸水形成 ,但在降低胸膜肥厚和粘连发生机会和程度方面不如尿激酶。

Objective To investigate the effects of intrapleural urokinase and corticosteroids in the prevention of pleural thickening and loculated pleural effusion.Methods Sixty-seven patients with tuberculous pleural effusions were randomized into 2 groups: GroupⅠ and GroupⅡ. The patients in GroupⅠ were injected with urokinase 100,000 IU intrapleurally after each thoracocentesis twice a week, while the patients in GroupⅡ were injected with corticosteroids 5 mg. Results The mean volume of the fluid drained in GroupⅠ was (3,109±439) ml, while it was (2,805±430) ml in GroupⅡ (P<0.01). The mean thickness of pleura in GroupⅠ was (0.81±0.23)mm, but it was (1.12±0.24)mm in GroupⅡ (P<0.01). The incidence of pleural adhesion and loculation in GroupⅠ was 11%, but it was 39% in GroupⅡ (P<0.01).Conclusion Although intrapleural corticosteroids can greatly decrease the volume of pleural effusion drained, it can not prevent pleural thickening and adhesion. Intrapleural urokinase can prevent pleural thickening and adhesion.