胸腔注入尿激酶抽液与引流治疗包裹结核性胸膜炎比较

目的胸腔置人引流管注入尿激酶后空针抽液（观察组）与自然引流（对照组）治疗包裹结核性胸膜炎疗效的比较。方法已形成包裹结核性胸膜炎患者72例，随机分成2组，观察组36例，对照组36例。两组患者均接受2H．R．Z．E／10H．R．E的口服抗痨方案，并予以胸腔穿刺置管，注入尿激酶20万IU1次／d；观察组每次注药后2h使用50ml空针于引流管接头处抽吸胸水至不能抽出为止，对照组注药后2h开放引流袋自然引流胸水至不能流出为止。注药前及注药后分别测定胸水中D-二聚体的含量，记录胸水吸收的时间（彩超测定未见胸水或胸水深度〈0．5em），胸水引流量，观察不良反应的发生率。结果两组注药后D-二聚体的含量均较注药前显著升高（P〈0．05）但观察组较对照组升高多，两组间差异有统计学意义（P〈0．05）。胸水消失时间，观察组较对照组短，两组间差异有统计学意义（P〈0．05）。胸水引流量两组间差异无统计学意义，不良反应主要为血性胸水、胸疼、高热，未见导管感染及气胸，两组问差异无统计学意义。结论胸腔内注入尿激酶后空针抽吸胸水治疗有包裹的结核性胸膜炎有明显疗效，可以缩短置管时间，同时不增加不良反应的发生率。

Comparative study on pumping pleural fluid or drainage after intrapleural injection of urokinase in treamting of Parcel tuberculous Pleurisy

Objective To compare pumping pleural fluid or natural drainage after intrapleural injection of urokinase in the treatment of tuberculosis encysted pleural effusion. Methods Seventy two patients with tuberculosis encysted pleural effusion were allocated into two groups randomly.36 cases in each group （observer Group and control group）.Chemotherapy regimens in all patients were 2HRZE/10HRE.Placed drainage tubes in pleural cavity,injected urokinase 200,000 units daily.Used the empty needle aspiration of pleural effusion 2 hours after injection of urokinase in observer Group. In control group ,we didn＇t aspiration of pleural effusion.D-dimer in pleural effusion were measured before injection and after 2 hours. Volume of pleural effusion and absorption time were recorded,the incidence of adverse reactions was observed. Results After injection the D-dimer levels in the pleural effusion were significantly higher in the two groups.D-dimer levels of the observation group was much higher than that in control group （P〈 0.05）.The hydrothorax disappearance time of observation group was shorter than the control group （P〈 0.05 ）.Volume of pleural effusion in the two groups were not different.The main adverse reactions are bloody pleural fluid, chest pain, fever, no infection and pneumothorax. Conclusions Pumping pleural fluid after intrapleural injection of urokinase had obvious curative effect,shorted the time of catheter, and did not increase the rate of adverse reaction.