透明质酸钠注入胸膜腔预防结核性胸腔积液胸膜肥厚、粘连的疗效观察及护理

目的 探讨胸膜腔内注射透明质酸钠(HA)预防结核性胸腔积液胸膜肥厚、粘连的效果及护理方法。方法 初治中等量结核性胸腔积液52例,随机分组,治疗组27例,对照组25例,两组化疗都按2HRZS/4HR,首次抽液后治疗组胸膜腔内注入透明质酸钠凝胶25 mg(2.5 ml),对照组胸膜腔内注入生理盐水2.5 ml,注药后指导、鼓励病人深呼吸,每10～20 min变动体位1次,依次平卧位、患侧卧位、患侧俯卧位,避免半坐卧位,尤其禁止长时间的半坐卧位。结果 治疗组胸穿次数较对照组显著减少(P<0.05),胸腔积液完全吸收时间治疗组较对照组显著变短(P<0.05),治疗组胸膜厚度注药前(0.92±0.11)cm较注药后(0.57±0.13)变化有显著性(P<0.05),胸膜厚度治疗组与对照组比较有显著性变化(P<0.05)。结论 胸膜腔内注入透明质酸钠凝胶可预防结核性胸腔积液胸膜肥厚、粘连、促进胸水吸收,合理护理疗效更佳。

Therapeutic Effect of Sodium Hyaluronic Acid in Preventing Pleural Thickening and Adhesion Caused by Tuberculous Pleural Effusion

Objective To investigate the nursing and the effect of hyaluronate based gel (HAbg) on prevention of pleural thickening and adhesion in tuberculous pleural effusions. Methods 52 patients who had middle amounts of tuberculous pleural effusion were divided into two groups at random. The patients of two groups were all give standard treatment with anti - tuberculous drugs (2HRZS/4HR). 25mg(2. 5ml) HAbg was injected into intrathoracic cavities of patients of the treatment group, while 2. 5ml 0. 9% NaCl was injected into intrathoracic cavity of the patients in the control group. After injection, all patients must change their position per 10 - 20 minutes and respire thoroughly. Results The patients who treated with HAbg had significantly thinner pleura, shorter time of pleural effusion absorption and fewer numbers of thoracentesis compared with the control group. Conclusions Intrathoracic injections HAbg can prevent pleural thickening of tuberculous pleural effusion. It is effective to give reasonable nursing care for the HAbg treated patients.