套管针穿刺胸膜腔闭式引流术治疗大量胸腔积液的临床分析

目的探讨套管针穿刺水封瓶胸膜腔闭式引流术治疗大量胸腔积液的疗效。方法回顾性分析结核性胸膜炎致大量胸腔积液160例,全部病例在抗痨治疗基础上,应用套管针穿刺水封瓶胸膜腔闭式引流术治疗为治疗组,常规胸穿术抽液治疗为对照组。对两组病例进行疗效分析。结果本组病例160例,其中治疗组89例,治疗后患者呼吸困难等症状较对照组明显缓解,胸水消失时间6±3．5d,对照组胸水消失时间15±5．4d,治疗组疗效明显优于对照组（P〈0．05）。结论套管针穿刺水封瓶胸膜腔闭式引流术治疗大量胸腔积液,全部患者均能顺利进行胸水引流,肺部压迫症状得到改善,缩短治疗时间,值得临床推广。     

中心静脉导管引流治疗结核性胸膜炎40例临床观察

目的观察用中心静脉导管行胸腔闭式引流与传统胸穿抽液对结核性胸膜炎的临床疗效。方法40例中等量以上胸腔积液患者随机分为两组,治疗组20例,应用中心静脉导管行胸腔积液引流术,对照组20例,常规用胸腔穿刺抽液2～3次/周,两组均正规抗痨治疗。观察临床症状,胸水吸收时间及综合疗效。结果平均退热时间治疗组较对照组时间缩短。胸水吸收时间,综合疗效比较,两组均有显著差异。结论应用中心静脉导管行胸腔闭式引流术能减轻症状,缩短胸水吸收时间疗效确切。     

190例超声指导胸腔积液治疗体会

目的 探讨超声指导胸腔积液治疗的临床价值.方法对190例胸腔积液的超声表现进行胸水性状分类,以指导临床治疗.结果 190例患者均根据积液的不同超声表现来指导临床进行不同的治疗,未出现穿刺及引流不成功的情况,治愈100%.结论超声用于胸腔积液诊断及指导临床治疗有其很大的应用价值.     

腔内注射利福平治疗结核性渗出性胸膜炎40例疗效分析

目的探讨利福平在治疗结核性渗出性胸膜炎中的疗效。方法 80例确诊为结核性渗出性胸膜炎患者,随机分为两组,每组40例。两组均采用2HRZE/10HRE,对照组每次常规抽胸水,隔日抽胸水一次;治疗组胸腔内置入中心静脉导管,胸水自动流出后胸腔内注入利福平0.3 g。结果治疗组患者临床症状明显改善,胸水吸收时间减短,胸膜肥厚粘连、包裹性积液等并发症发生率与对照组比较有统计学差异。结论胸腔内注射利福平在治疗结核性渗出性胸膜炎中疗效显著,值得在临床应用中进一步推广应用。     

以胸腔积液为首发症状的淋巴瘤12例临床分析

目的:提高对以胸腔积液为首发症状的特殊类型淋巴瘤的认识。方法:回顾性分析12例以胸腔积液为首发表现,疑似"结核性胸膜炎",最后经手术病理检查、胸水细胞学检查及追踪确诊为淋巴瘤患者的临床资料。结果:12例患者均以胸腔积液为首要表现,1例伴有腋窝淋巴结肿大,其余11例无其他淋巴组织损害,胸水均为渗出液,最后经胸水细胞学、手术病理检查及追踪诊断为淋巴瘤。结论:少数淋巴瘤患者以胸腔积液为首发表现,可能与原发于胸膜淋巴组织有关,诊断困难,易误诊为结核性胸膜炎。对抗结核治疗反应欠佳且胸水腺苷脱氨酶明显增高者,应特别警惕淋巴瘤可能,宜尽快行胸腔镜检查明确诊断。     

胸腔细管引流治疗结核性胸腔积液48例临床分析

目的评价胸腔细管引流治疗结核性胸腔积液的疗效。方法单侧结核性胸腔积液患者,其中56例为常规间断胸腔穿刺抽液者,48例为经胸腔细管引流者,分析两组患者在胸水引流并发症,胸膜粘连发生率,胸水消失时间的差别。结果与间断胸腔穿刺抽液治疗方法比较,胸腔细管引流并发症少,胸膜粘连发生和胸膜肥厚发生率降低,胸水消失时间和平均住院日缩短。结论胸腔细管引流是治疗结核性胸腔积液的经济、创伤性小的有效辅助治疗方法,值得临床推广应用。     

微导管引流及胸腔内给药治疗结核性胸腔积液的疗效观察

目的　探讨结核性渗出性胸腔积液治疗方式。方法 在全身规则抗结核治疗下，治疗组42例结核性渗出性胸腔积液患者，采用微导管引流胸液及腔内药物注入法。对照组 42例按常规方式进行治疗。结果 治疗组胸水控制率为 100%，达到完全好转 93%，部分好转 7%。对照组胸水控制率为 86%，达到完全好转 76%，部分好转 10%，好转 14%。结论 微导管引流胸腔积液和腔内注药治疗结核性渗出性胸腔积液的方法方便、安全，疗效满意，值得在临床上推广应用。     

胸腔积液为首发表现的多发性骨髓瘤8例临床分析

目的 探讨以胸腔积液为首发表现的多发性骨髓瘤胸腔积液特点及诊断.方法 分析我院8例以胸腔积液为首发表现的多发性骨髓瘤临床资料.结果 8例患者胸腔积液均为渗出液,胸水细胞以淋巴细胞为主,经引流后胸水减少.结合患者外周血球蛋白明显升高、贫血、血沉加快,进一步行球蛋白电泳及骨髓检查确诊为多发性骨髓瘤.结论 胸腔积液为呼吸科常见病,病因复杂,多发性骨髓瘤患者可以胸腔积液为首发表现,其胸腔积液产生原因可能与其并发症有关,对于诊断特异性不高,需综合分析各项临床指标.     

26例肺炎旁胸腔积液临床分析

目的探讨肺炎旁胸腔积液不同类型的治疗方法。方法复习26例不同类型肺炎旁胸腔积液的临床特点、治疗方法及预后。结果本组26例四种类型肺炎旁胸腔积液主要临床表现为咳嗽、咳痰、胸痛、发热,分别给予对症治疗,其中15例行胸穿抽液,3例行胸腔闭式引流术。除1例伴有慢性肺源性心脏病死亡外,分别在第2～6月后随访25例,胸水均完全吸收,临床症状均消失,其中4例出现胸膜增厚。结论混合复杂性肺炎旁胸腔积液和单纯复杂性肺炎旁胸腔积液需积极多次抽胸水并胸腔内注入纤维蛋白溶解剂,必要时行胸腔闭式引流术,治疗积极预后好,否则易造成积液吸收延迟及胸膜增厚。     

全身化疗腔内免疫序贯治疗肺癌合并胸腔积液临床研究

目的研究全身化疗腔内免疫序贯治疗肺癌胸腔积液的临床疗效及免疫指标变化。方法将45例肺癌合并胸腔积液息者随机分两组治疗，两组均予以GP方案化疗2个周期，化疗第15天尽量排净胸水。治疗组并胸腔内注射白介素-2，连续4次；对照组仅间断放胸水。观察两组治疗前后胸水中树突状细胞数量及治疗后胸水缓解率。结果治疗组临床有效率、胸水中树突状细胞数量均明显高于对照组（P〈0．01）。结论全身化疗腔内免疫序贯治疗肺癌合并胸腔积液可增加患者免疫功能，提高临床疗效。     

Tuberculous pleural effusion. Twenty-year experience

We reviewed the records of 1,738 cases of tuberculosis seen during the period from 1968 to 1988 in Mobile, Alabama. Seventy cases of tuberculous pleural effusion were identified and constituted 4.9 percent of all disease due to Mycobacterium tuberculosis during this period. Tuberculous pleural effusion was diagnosed if the patient had M tuberculosis cultured from sputum, pleura, or pleural fluid and had a roentgenographic pleural effusion without an alternative explanation for the presence of the effusion. The diagnosis of tuberculous pleural effusion was made in the absence of a positive culture if the patient had an undiagnosed lymphocytic exudative pleural effusion and all clinical and roentgenographic abnormalities resolved on antimycobacterial chemotherapy. The mean age of all patients was 47 +/- 18.4 years. The 70 cases were evenly divided between 35 that were accompanied by roentgenographic pulmonary parenchymal infiltrates and 35 that occurred in the absence of parenchymal infiltrates. We conclude that cultures of all potentially diagnostic specimens (sputum, pleural fluid, and pleura) and an intermediate-strength skin test, are sensitive tests for the diagnosis of tuberculous pleural effusion. In addition, the age of patients with tuberculous pleural effusion appears to be increasing.     

可溶性髓系细胞触发受体-1表达水平与胸腔积液性质的相关性

目的:探讨可溶性髓系细胞触发受体-1(sTREM-1)表达水平与胸腔积液性质的相关性。方法:选择胸腔积液患者84例为研究对象(分为4组:结核性胸水24例;细菌性胸水22例;肿瘤性胸水16例;漏出液22例)。用酶联免疫吸附法(ELISA)分别检测患者胸水和血清中sTREM-1的表达水平,并分析比较。结果:4组患者胸水中,细菌性胸水组sTREM-1表达增高最显著,肿瘤性胸水组次之,漏出液胸水sTREM-1表达最低。4组患者血清中,细菌性胸水组sTREM-1的表达增高也最为显著,其他3组间差异无统计学意义。结论:sTREM-1表达水平对细菌性胸水、结核性胸水、肿瘤性胸水以及漏出液的鉴别诊断有较好价值,特别是对以胸膜细菌感染时胸水的诊断有较重要意义。     

Endoscopic transpapillary nasopancreatic drainage alone to treat pancreatic ascites and pleural effusion

BACKGROUND: Pancreatic ascites and pleural effusion are uncommon sequelae of pancreatitis and are associated with significant morbidity and mortality. Endoscopic decompression of the pancreatic duct through transpapillary stent or nasopancreatic drain (NPD) has shown encouraging results but the experience is limited. The aim of the present study was to evaluate the efficacy of endoscopic transpapillary nasopancreatic drainage in patients with pancreatic ascites and pleural effusion. METHODS: Over a period of 9 years, 10 patients (eight male) with pancreatic ascites and/or pleural effusion with pancreatic duct disruption documented on pancreatogram were studied. After informed consent, endoscopic transpapillary NPD was placed. The end-points were resolution of ascites and/or pleural effusion or need for surgery. RESULTS: Of 10 patients (age range: 13 months-46 years), four patients had only ascites, four had only pleural effusion and two had both ascites and pleural effusion. Ascites and/or pleural effusion resolved in all the patients within 4 weeks of placement of NPD. The healing of ductal disruption was demonstrated by nasopancreatogram as early as 2 weeks and NPD could be removed without necessitating another endoscopy. No major complications related to NPD placement were noted. There was no recurrence of pancreatic ascites and/or pleural effusion at a mean follow up of 39 months. CONCLUSIONS: Pancreatic ascites and pleural effusion can be effectively treated by endoscopic retrograde pancreatography and transpapillary NPD placement.     

Value of ultrasonography in determining the nature of pleural effusion: Analysis of 582 cases

To explore the value of ultrasonography in the auxiliary diagnosis of pleural effusion, we retrospectively analyzed the ultrasonographic findings of 275 exudates and 307 transudates and summarized the ultrasonographic image features of pleural effusion according to patients’ primary diseases. The findings of thoracic ultrasonography performed before the initial thoracentesis in 582 patients with subsequently confirmed exudative/transudative pleural effusion were analyzed with regard to the sonographic features of pleural effusion. In 275 cases with exudates, thoracic ultrasonography showed a complex septate appearance in 19 cases (6.9%), complex nonseptate appearance in 100 cases (36.4%), complex homogenous sign in 46 cases (16.7%), and pleural thickness > 3 mm in 105 cases. In contrast, in 307 patients with transudates, most patients (97.1%) had bilateral pleural effusion. Ultrasonographic images displayed anechoic appearance and absence of pleural thickening in a vast majority of cases (306, 99.7%; 301, 98%). These positive findings in the exudate were statistically higher than those in their counterparts (P < .05). In the empyema subgroup, the proportion of complex septate appearance, complex nonseptate appearance, complex homogenous sign, and pleural thickening was the highest, at 19/41, 12/41, 10/41, and 30/41, respectively. Ultrasonography is valuable in defining the nature of pleural effusion. Some sonographic features of pleural effusion, such as echogenicity, septation, and pleural thickening, may indicate a high risk of exudative pleural effusion.     

急性胰腺炎胸腔积液与病情严重程度关系分析

目的 分析急性胰腺炎(AP)患者胸腔积液的发生率,探讨胸腔积液与病情严重程度的关系.方法 回顾性分析766例AP患者胸腔积液的发生率及其与发病年龄、性别、Ranson评分、CT分级(CTSI)、血淀粉酶水平、白蛋白含量以及住院天数之间的关系.结果 766例AP患者中,129例(16.8%)发生胸腔积液.171例重症急性胰腺炎(SAP)中38例(22.2%)发生胸腔积液,595例轻症急性胰腺炎(MAP)中91例(15.3%)出现胸腔积液,SAP患者的胸腔积液发生率显著高于MAP患者(P＜0.05).发生胸腔积液患者的血淀粉酶水平、白蛋白含量、Ranson评分、CTSI及住院天数分别为(795±1013)U/L、(36±7)g/L、1.12±1.15、4.02±1.16和(23.4±23.4)d;无胸腔积液者分别为(592±856)U/L、(38±6)g/L、0.85±0.98、3.15±16.60和(17.3±16.6)d.胸腔积液患者的Ranson评分、血淀粉酶水平、CTSI均显著高于无胸腔积液者(P＜0.05或＜0.01);血清白蛋白含量显著低于无胸腔积液者(P＜0.01);住院天数明显长于无胸腔积液者(P＜0.01).双侧胸腔积液92例,右侧胸腔积液11例,左侧胸腔积液26例,胸腔积液部位与病情无关,但左侧胸腔积液者住院天数较长(P＜0.05).结论 AP患者发生胸腔积液者病情较重,胸腔积液可能是个较好的评估SAP的指标.     

14例心源性胸腔积液误诊分析

目的　分析心源性胸腔积液的误诊原因。方法 对 14例心源性胸腔积液患者的临床特征进行回顾性分析。结果 (1) 45岁以上 12例,平均年龄 59.4岁。 (2) 10例患者有夜间阵发性呼吸困难、心界增大、肝大触痛、下肢水肿,8例病人有颈静脉怒张等心衰症状体征。 (3)心电图均有ST-T改变,提示心肌缺血或劳损,合并心律失常 10例。 (4)胸部X线或CT示全部病例均有不同程度的间质性或 /和肺泡性肺水肿影像。心影增大 10例,双侧胸腔积液 13例。胸液细胞计数多不符合典型漏出液改变。 (5)临床诊断:冠心病 8例 (其中合并心包炎 1例,高血压病 3例)、心肌病、肺心病各 2例、甲亢性心脏病、高血压性心脏病各 1例。全部病例均合并肺部感染和充血性心力衰竭。结论 心源性胸腔积液多见于中老年,均存在引起或诱发心力衰竭的基础疾病和诱因。常多种疾病并存,相互影响,掩盖或加重心脏的症状或体征,影响胸液检查结果,导致诊断困难。认真、严密、细致的临床观察和对病史、临床资料的综合分析可防止误诊。     

内科胸腔镜在不明原因胸腔积液诊断中的应用

目的 分析内科胸腔镜在不明原因胸腔积液诊断中的价值及其安全性.方法 对我院呼吸内科及重症医学科2010年4月至2013年4月收治的92例不明原因胸腔积液患者行内科胸腔镜检查,观察胸膜病变,直视下病变处多部位活检并行病理检查.结果 92例胸腔积液患者确诊84例,诊断阳性率为91.3％,其中恶性胸腔积液48例,结核性胸腔积液29例,非特异性炎症4例,化脓性胸膜炎2例,结节病1例,病因不明8例,术后疼痛11例,发热3例,出血1例.结论 内科胸腔镜检查有助于进一步明确不明原因胸腔积液的病因,且患者耐受性好、安全、有效,值得临床推广应用.     

超声引导下改良胸膜活检术对诊断原因不明胸腔积液的临床观察(附49例临床分析)

目的 观察超声引导下改良胸膜活检术对原因不明胸腔积液诊断中的价值.方法 使用改良胸膜活检术对49例不明原因胸腔积液患者进行胸膜活检术.结果 所有患者胸膜活检均成功,其中间皮瘤3例,低分化癌6例,腺癌7例,未分型4例,结核18例,慢性炎症11例(经治疗最终证实为结核),病理确诊率77.6％,仅2例出现胸膜反应,未出现局部出血及气胸.结论 超声引导下改良胸膜活检术安全、方便,对胸腔积液确诊率高、并发症少.     

胸水N-末端脑钠肽前体在胸腔积液患者中的诊断价值

目的 探讨检测胸液中N-末端脑钠肽前体(NT-proBNP)对于胸腔积液的鉴别诊断价值.方法 选取在本院因胸腔积液而进行诊断性胸腔穿刺的患者126例,根据临床表现、胸液常规检验结果及细胞学分为充血性心力衰竭胸腔积液33例(心源性组)和非心源性组93例(恶性胸腔积液18例、结核性胸腔积液22例、肾功能衰竭性胸腔积液19例、肝硬化腹水伴胸腔积液15例、肺炎性胸腔积液19例).检测2组患者胸水及血浆中NT proBNP水平,分析血浆NT proBNP水平与胸水NT-proBNP的相关性,并采用受试者工作曲线(ROC)计算用于判别胸水性质的最佳界值.结果 心源性组胸水及血浆中的NT-proBNP水平显著高于非心源性组、恶性组、结核组、肾功能衰竭组、肝硬化组和炎症组,且差异均具有统计学意义(P＜0.05);恶性组、结核组、肾功能衰竭组、肝硬化组和炎症组胸水及血浆中NT proBNP水平差异均无统计学意义(P＞0 05);胸水中NT proBNP水平与血浆中NT-proBNP水平呈显著正相关(r=0.894,P＜0.01).绘制ROC曲线结果显示,当胸水中NT-proBNP水平为1 500 ng/L时,鉴别心源性和非心源性胸水具有最大诊断指数(1.757 3),此时敏感度为89.19％、特异度为86.54％.结论 心源性胸腔积液患者胸水中NT-proBNP水平显著升高,与血浆水平呈显著正相关,以1 500 ng/L为界值时,具有鉴别诊断心源性胸水的最高价值.     

Adenosine deaminase activity in pleural fluid--a diagnostic test of tuberculous pleural effusion.

Adenosine deaminase (ADA) activity in pleural fluids was studied in 47 patients with pleural effusion of different etiology. Patients were divided into two groups: Group I - Tuberculous pleural effusion (21 patients): Group II - Non tuberculous effusion (26 patients) and these included malignant pleural effusion (9 cases), synpneumonic pleural effusion (9 cases) and transudative pleural effusion (8 cases). The mean ADA activity was 64.67 IU/L +/- 21.68 in group I and 6.99 +/- 3.69 in Group II. Increased mean pleural fluid ADA activity in tuberculous pleural effusion was highly significant (p < 0.001) when compared with pleural effusion of non-tuberculous etiology. Based on lowest value of ADA activity found in tuberculous pleural effusion (30 IU/L), the test has a sensitivity and specificity of 1.