留置中心静脉导管引流与单纯多次间断胸腔穿刺抽液治疗结核性胸腔积液60例临床对比分析

目的 评价留置中心静脉导管引流与单纯多次间断胸腔穿刺抽液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60例为常规间断胸腔穿刺抽液者,60例为留置中心静脉导管引流者,分析两组患者在胸水引流并发症,胸穿次数,胸膜肥厚粘连发生率,胸水消失时间及平均住院天数的差别. 结果 与间断胸腔穿刺抽液治疗方法 比较,留置中心静脉导管引流并发症少,胸穿次数少,胸膜肥厚、粘连发生率低,胸水消失时间和平均住院天数缩短. 结论 留置中心静脉导管引流是治疗结核性胸腔积液的经济、创伤性小的有效方法 ,值得临床推广.     

胸腔微创置管引流并糜蛋白酶治疗结核性胸腔积液

目的探讨胸腔微创置管引流并糜蛋白酶治疗结核性胸腔积液的疗效。方法患者在抗结核治疗条件下，将52例结核性胸腔积液患者随机分为治疗组（28例）对照组（24例），治疗组胸腔微创置管引流，并经引流管注入糜蛋白酶5mg。对照组行胸腔穿刺抽液。结果与对照组相比胸水消失时间明显缩短，胸膜粘连、肥厚发生率明显降低。结论胸腔微创置管引流并糜蛋白酶治疗结核性胸腔积液的方法安全，疗效明显，值得在临床上推广应用。     

中心静脉导管胸腔闭式引流在治疗结核性胸腔积液中的应用价值

目的探讨中心静脉导管胸腔闭式引流在治疗结核性胸腔积液中的应用价值。方法对引流组和抽液组的穿刺次数,胸液引流量,胸液消失时间及发生胸膜肥厚的情况进行统计分析。结果引流组与抽液组相比较,穿刺次数减少,胸液引流量多,胸液消失时间快,并发症少,发生胸膜肥厚少。结论中心静脉导管胸腔闭式引流在治疗结核性胸腔积液中的价值优于常规胸腔穿刺抽液,值得推广。     

两种不同方法对结核性胸腔积液的诊疗观察

目的研究胸腔镜联合胸腔闭式引流结合的方法与传统胸腔穿刺抽液联合胸膜活检对大量结核性胸腔积液的临床诊疗效果。方法抽取100例大量结核性胸腔积液病例,将其分为A、B两组,每组50例。分别采用反复胸腔穿刺抽液联合胸膜活检(A组)与胸腔镜联合胸腔闭式引流(B组)联合的方法进行处理。结果 B组患者的诊断率及临床好转率明显高于A组。经过治疗后的体温恢复正常和胸水控制所需的时间明显短于A组;治疗过程中的实际胸水抽放量明显多于A组;胸膜粘连包裹发生率及胸膜增厚发生率明显低于A组;结论胸腔镜与胸腔闭式引流结合的方法对胸腔积液的诊治是简单、快速、有效、安全。     

胸腔内置管治疗结核性胸腔积液的价值

目的探讨胸腔内留置中心静脉导管在治疗结核性胸腔积液的应用价值。方法对住院患者60例结核性胸腔积液分为引流组30例和抽液组30例,将两组病人的引流、胸液、胸水排净时间和导致胸膜增厚的程度进行对比。结果引流组与抽液组比,穿刺次数少,排液持续时间长,引流胸液量大,胸液排净时间短、并发症少,引成胸膜增厚明显减少。结论胸腔内置管治疗结核性胸腔积液优于胸穿抽液术,方便、安全、疗效满意,值得在临床推广应用。     

中心静脉导管胸腔闭式引流术在结核性胸腔积液治疗中的应用价值

目的探讨中心静脉导管观察在治疗结核性胸腔积液的应用价值。方法对住院患者78例结核性胸腔积液分为引流组(31例)和抽液组(47例),将2组病人的引流、抽液、胸水排净时间、排出胸水量和导致胸膜肥厚的程度进行对比。结果引流组与抽液组对比,穿刺次数减少,排液持续时间长,引流胸液量大,胸液排净时间短,并发症少,造成胸膜肥厚明显减少。结论中心静脉导管胸腔闭式引流术治疗结核性胸腔积液优于常规胸穿抽液术。     

尿激酶治疗结核性包裹性胸腔积液疗效观察

目的评估胸腔内注射尿激酶、辅助用泼尼松及单纯胸腔抽胸腔积液（胸液）3种方法对结核性包裹性胸液患者胸液引流量、胸液消退时间及胸膜增厚的影响。方法将78例结核性胸膜炎患者随机分为尿激酶组、泼尼松组和单纯抽胸液组。给予尿激酶组患者胸腔内注射10万单位尿激酶后持续胸腔引流,泼尼松组患者每日服用泼尼松25mg加间断胸腔穿刺抽胸液,给予单纯抽胸液组患者单纯间断胸腔穿刺抽液。观察抽出的胸液量、胸液消退时间、胸液消退后及胸液消退后6个月时胸膜厚度。结果尿激酶组胸液引流量较其他2组明显多,胸液消退时间较其他2组短,胸膜厚度也较其他2组轻。结论胸腔内注射尿激酶治疗结核性包裹性胸液能有效防止胸膜增厚,缩短胸液消退时间。     

利福平注射液胸腔注入治疗结核性胸腔积液

结核性胸腔积液的纤维蛋白沉积于胸膜形成胸膜肥厚,对心肺功能造成危害,胸穿抽液虽可以解除肺及心血管的受压,改善呼吸,但由于胸膜炎症的存在,胸穿抽液后胸水继续渗出。本文在常规治疗基础上,采用利福平注射液(商品名舒兰新,沈阳双鼎制药有限公司生产)胸腔注入治疗结核性胸腔积液,临床观察疗效显著,并发症少,无明显副作用。在胸腔积液消失率、胸水平均消失时间及平均胸腔穿刺次数等方面均明显优于对照组,且其胸膜肥厚粘连及胸腔感染等并发症亦均少于对照组。     

结核性胸腔积液治疗进展

结核性胸腔积液易形成胸膜增厚 ,影响肺功能。如何尽快地排出胸腔积液 ,减轻或避免胸膜增厚是结核性胸腔积液治疗中的一个重要课题。国内近年来取得了一些进展 ,现综述如下。1.胸液引流方法的改进对于结核性胸腔积液传统治方法是对大量胸液者每周抽液 2～ 3次 ,直至胸液完全吸收 [1 ]。每次抽液量一般不宜超过 10 0 0 ml。其缺点是胸液往往不易很快抽尽。(1)导管引流法 :本方法是经超声定位 ,用套管针进行胸腔穿刺 ,穿刺成功后经套管针胸腔内置入中心静脉导管进行引流 ,可持续引流也可间断引流 [2～ 4 ]。彭卫东等报道一组 4 3例用本方法持…     

静滴式引流术在结核性胸腔积液治疗中的应用价值探讨

目的：探讨静滴式引流术在结核性胸腔积液治疗中的应用价值。方法：217例结核性胸腔积液按不同治疗方法分为引流组（53例）、抽液组（107例）及保守组（57例），对3组病人的引流，抽液的穿刺次数，持续时间，排出的胸液量及发生胸膜肥厚的情况进行统计分析对比。结果：引流组与抽液组相比，穿刺次数明显减少，排液持续时间长，首次引流胸液量大，且无并发症。遗留胸膜肥厚，引流组明显少于其他两组。结论：静滴式引流术用于结核性胸腔积液的疗效优于常规胸穿抽液术及保守疗法。     

胸腔内留置深静脉管并注入尿激酶治疗结核性包裹性胸腔积液

目的探讨胸腔内留置深静脉管并注入尿激酶治疗结核性包裹性胸腔积液的疗效。方法抗结核治疗下,治疗组在胸腔内置入深静脉管,引流出胸液后,再注入尿激酶10万u加生理盐水30ml。对照组常规胸腔穿刺抽胸水至不能抽出为止。结果治疗组胸水引流量显著多于对照组,遗留胸膜肥厚明显少于对照组。结论胸腔内留置深静脉管并注入尿激酶对结核性胸腔积液的引流、减少包裹、粘连有显著疗效,值得在临床上推广应用。     

胸腔置管向胸腔内注入尿激酶治疗结核性包裹性胸腔积液的疗效观察

目的观察胸膜腔内置引流管注入尿激酶治疗结核性包裹性胸液效果。方法将60例结核性包裹性胸腔积液患者随机分成两组，在规则抗结核治疗基础上，对治疗组患者经内置引流管向胸腔内注射尿激酶10万单位，对照组胸腔内注入异烟肼0．1g及地塞米松5mg作对照。结果治疗组30例中有5例（16．6％）完全吸收，16例大部分吸收，好转9例，无效1例，总有效率96．66％，对照组30例中有0例（0％）完全吸收，4例大部分吸收，好转10例，无效16例，总有效率46．66％，结论通过胸腔内置引流管注入尿激酶治疗结核性包裹性胸腔积液明显优于传统的注入异烟肼及地塞米松，且减少穿刺次数，减轻患者痛苦，节省费用，付作用小，是一种安全有效的方法。     

胸膜腔内注入尿激酶预防结核性渗出性胸膜炎所致胸膜肥厚和包裹性积液的研究

目的　探讨胸膜腔内注入尿激酶（urokinase,UK）对结核性渗出性胸膜炎所致胸膜肥厚和粘连包裹的影响。方法　81例收治的结核性粘连包裹性胸膜炎患者随机分为注药组(42例)和非注药组(39例),注药组于每次抽液后注入尿激酶10万IU,其他治疗相同。结果　注药组抽液总量(3891±573)ml,而非注药组(3045±498)ml(P<0.01),注药组胸膜厚度(1.10±0.20)mm,而非注药组(1.40±0.30)mm(P<0.01),胸膜粘连发生率注药组10%,非注药组36%(P<0.01),平均注药次数(4.6±1.4)(3～8)次。同时发现胸液消失时间略有延长,但同对照组相比差异无显著性。结论　胸膜腔内注入尿激酶能显著增加胸液引流量,能有效降低胸膜肥厚和粘连发生的机会和程度,与对照组相比差异有显著性。     

A study of loculated tuberculous pleural effusions treated with intrapleural urokinase

AIM: To assess the effect of intrapleural urokinase, vis-à-vis simple pleural drainage, on residual pleural thickening in a series of patients suffering from loculated tuberculous pleural effusion. PATIENTS AND METHOD: Twenty-nine patients (21 males and 8 females) with loculated pleural effusion were studied. These patients were randomly allocated to one of two groups: one group received intrapleural urokinase (n=12) and the other was treated by simple drainage with suction (n=17). The urokinase (125,000 UI) was administered into the pleural cavity via an intrathoracic tube. This procedure was repeated every 12h until the quantity of pleural fluid obtained was less than 50 cm3, at which point the intrathoracic tube was removed. RESULTS: In both groups, the biochemical analysis of the pleural fluid was an exudate and the fluid had a serous appearance. Pleural thickening when the drainage tube was removed was 8.09+/-3.36 mm for the group treated with urokinase, and 14.78+/-17.20mm (P>0.05) for the control group. Residual pleural thickening measured upon completion of medical treatment at 6 months was 1.45+/-0.89 mm for the group treated with urokinase and 7.47+/-10.95 mm for the control group (P<0.05). In the control group, only two patients presented over 10mm of residual pleural thickening. The mean quantity of fluid drained in the two groups was 1.487+/-711 ml for the patients with urokinase, and 795+/-519 ml for the control group (P<0.01). CONCLUSION: Our study shows that patients with loculated tuberculous pleural effusion treated with urokinase suffered less from residual pleural thickening, as measured after six months, than those treated by simple drainage. It is therefore suggested that the administration of intrapleural urokinase is a safe and effective treatment for those patients who drain a larger quantity of pleural fluid.     

超声引导下胸膜腔注入尿激酶治疗结核性胸腔积液

目的探讨超声引导下胸膜腔注入尿激酶治疗结核性多房性胸腔积液的临床价值。方法对42例结核性胸腔积液患者超声引导下注入生理盐水50ml稀释的尿激酶10万IU,24小时后抽尽液体,如仍有积液与分隔,重复上述治疗。结果第1次注入尿激酶后抽液量较用药前明显增多,第2~4次用药后抽液量增多不明显。总有效率为95.2%。结论超声引导下胸膜腔注入尿激酶是治疗结核性胸腔积液一种安全有效的方法。     

胸腔置管联合透明质酸钠防治结核性胸膜炎胸膜肥厚研究

目的 观察中心静脉导管联合透明质酸钠防治结核性胸膜炎胸膜肥厚的疗效,探讨其作用机制.方法 64例符合结核性胸膜炎诊断标准、中至大量游离性胸腔积液患者,采用随机化原则分为治疗组和对照组.治疗组采用微创置管方法于患侧胸腔内插入中心静脉导管,胸腔积液完全引流后,注入透明质酸钠凝胶2.5 ml;对照组常规胸膜腔穿刺抽液,第2次抽液后注入2.5 ml生理盐水作对照.第1次抽液当日两组均给予标准抗痨方案,即2HRZE/4HR,注药前、注药后72 h、注药后3个月分别测量患侧胸膜厚度.结果 59例患者参与最后结果分析.治疗组患者呼吸困难开始缓解的时间、发热时间、胸腔积液完全引流时间、住院天数短于对照组(P＜0.01或P＜0.05),治疗组胸腔积液引流量高于对照组(P＜0.05);治疗组较对照组可降低胸腔积液中乳酸脱氢酶、总蛋白(P值均＜0.01)及白细胞水平(P＜0.05);治疗组在注药后72 h及注药后3个月胸膜厚度F(5.75±2.10)mm,(3.81±2.42)mm]均小于对照组[(8.29±2.62)mm,(7.47±2.85)mm,P值均＜0.01].结论 胸腔置入中心静脉导管联合透明质酸钠可较快地缓解患者因胸腔积液压迫肺造成的呼吸困难,缩短住院时间,减轻胸膜肥厚的程度.     

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.     

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.     

C反应蛋白在结核性及恶性胸腔积液鉴别诊断中的价值

目的　探讨 C反应蛋白 (CRP)测定在结核性及恶性胸腔积液鉴别诊断中的价值。方法　对 32例结核性或恶性胸腔积液患者的胸水、血清 CRP浓度及胸水 CRP/血清 CRP进行对比分析。结果　结核性胸液组胸水CRP浓度、血清 CRP浓度、胸水 CRP/血清 CRP均高于恶性胸液组 (分别为 P<0 .0 0 1,P<0 .0 1,P<0 .0 5 )。结论　 CRP测定有助于对结核性与恶性胸腔积液的鉴别。     

降钙素原与CA125联合检测对结核性胸腔积液的诊断价值

目的探讨联合检测血清和胸腔积液降钙素原(PCT)、CA125对结核性胸腔积液的诊断价值。方法 30例结核性胸腔积液、20例肺炎旁积液、30例恶性胸腔积液,采用化学发光法测定血浆和胸腔积液中的PCT水平,快速发光免疫分析测定CA125的水平。结果结核组、肺炎组血清PCT水平差异无统计学意义(P>0.05),结核组和肺炎组胸腔积液中PCT的表达均较对照组明显升高(均P<0.05)。结核组和恶性组血清及胸腔积液中CA125水平较肺炎组显著升高(P<0.01)。结论联合检测血清及胸腔积液中PCT与CA125水平可提高结核性胸腔积液诊断的敏感性和特异性。