高聚生联合顺铂治疗恶性胸腔积液的临床观察

目的：观察高聚生联合顺铂胸腔内灌注对恶性胸水的疗效。方法：60例肺癌继发恶性胸腔积液在胸腔置入中心静脉导管引流胸液后灌注高聚生及顺铂与单用顺铂疗效对照。结果：高聚生＋顺铂组60例,有效率81．7％;单纯灌注顺铂54例,有效率46．3％（P〈0．05）。局部化疗后KPS评分比治疗前明显上升。经中心静脉导管置入胸腔引流胸液安全有效,副作用小,患者能接受。结论：中心静脉导管置入胸腔灌注高聚生加顺铂,疗效明显优于胸腔内单纯灌注顺铂,因此生物制剂高聚生加顺铂经中心静脉导管置入胸腔内灌注为治疗恶性胸水的有效方法之一。     

胸腔置管引流顺铂联合干扰素治疗恶性胸腔积液38例分析

目的：观察胸腔置管引流顺铂联合丁扰素治疗恶性胸腔积液的疗效和毒副作用。方法：中心静脉导管胸腔穿刺置管引流，顺铂联合干扰素胸腔内灌注治疗恶性胸腔积液38例。结果：CR7例（18．4％），PR27例（71．1％），NC4例（10．5％），总有效率（CR＋PR）达89．5％。结论：中心静脉导管胸腔穿刺置管引流，顺铂联合干扰素治疗恶性胸腔积液疗效高、安全性好、患者痛苦少、毒副作用小。     

细管引流后高聚生联合顺铂治疗恶性胸腔积液患者的护理

目的总结高聚生与顺铂治疗恶性胸腔积液患者的护理经验。方法对62例恶性胸腔积液患者均以中心静脉导管接简易负压吸引瓶进行胸腔闭式引流,待胸腔积液引流完全后,注入高聚生与顺铂。注药前充分引流,术中、术后指导患者积极配合及更换体位,密切观察病情变化及不良反应。结果62例患者中,有效54例,有效率达87．1％。结论术中、术后患者的积极配合、注药前胸腔积液的充分引流,指导患者更换体位可提高临床疗效,同时能减少不良反应的发生。     

细管引流后高聚生联合顺铂治疗恶性胸腔积液患者的护理

目的 总结高聚生与顺铂治疗恶性胸腔积液患者的护理经验.方法 对62例恶性胸腔积液患者均以中心静脉导管接简易负压吸引瓶进行胸腔闭式引流,待胸腔积液引流完全后,注入高聚生与顺铂.注药前充分引流,术中、术后指导患者积极配合及更换体位,密切观察病情变化及不良反应.结果 62例患者中,有效54例,有效率达87.1%.结论 术中、术后患者的积极配合、注药前胸腔积液的充分引流,指导患者更换体位可提高临床疗效,同时能减少不良反应的发生.     

高聚生联合顺铂胸腔灌注治疗恶性胸腔积液

目的：观察高聚生联合顺铂治疗恶性胸腔积液的疗效及不良反应.方法：将48例恶性胸腔积液患者随机分为两组,两组患者尽量放尽胸水.治疗组24例采用高聚生加顺铂治疗;对照组24例单用顺铂治疗.结果：治疗组有效率87.5%,对照组有效率58.3%,治疗组明显好于对照组.结论：高聚生加顺铂治疗恶性胸腔积液疗效好,不良反应少.     

恶性胸腔积液导管引流并胸腔化疗的疗效观察

目的：观察恶性胸腔积液采用中心静脉导管引流并胸腔化疗的疗效。方法：恶性胸腔积液患者分为两组，一组采用中心静脉导管引流尽胸腔积液后注入卡铂联合四环素的方法治疗（治疗组），另一组采用引流并注入四环素的方法治疗（对照组），观察其疗效和毒副作用。结果：治疗4周后观察，治疗组疗效优于对照组，两组比较差异有显著性（X^2=4．33，P〈0.05）；不良反应两组比较差异无显著性（P〉0．05）。结论：用中心静脉导管引流并胸腔化疗治疗恶性胸腔积液疗效高、简单、安全，值得推广应用。     

持续引流胸腔内注射顺铂联合高聚生治疗恶性胸水临床观察

目的:研究顺铂联合高聚生胸腔内注射治疗恶性胸水的近期疗效及不良反应。方法:46例恶性胸水患者随机分成治疗组和对照组,持续胸腔闭式引流24 h,排尽胸水后,治疗组胸腔内注入顺铂60 mg,高聚生4 000 u;对照组胸腔内注入顺铂60 mg。每周1次,2~3次为1个疗程。4周后评价疗效。结果:治疗组总有效率83.3%,对照组总有效率50.0%,两组比较差异有统计学意义(P<0.05)。结论:持续引流胸腔内注射顺铂联合高聚生治疗恶性胸水疗效满意,值得临床应用。     

中心静脉导管持续引流加胸腔内化疗治疗恶性胸水的疗效及护理

目的：比较中心静脉导管持续引流加胸腔注药化疗与常规胸腔穿刺抽液注药化疗的疗效、副作用和护理措施。方法：48例恶性胸水患者分为两组：①治疗组：25例，采用中心静脉导管持续引流加胸腔内注入IL-2＋顺铂；②对照组：23例，采用胸腔穿刺抽液并注入同上药物。观察两组的疗效、副作用和护理效果。结果：治疗组有效率为84％；对照组有效率为43．48％。两组疗效对比有统计学差异，治疗组疗效优于对照组。两组少数患者出现发热、胸痛、恶心和呕吐等副反应，元明显统计学差异。结论：与胸腔穿刺抽液相比，中心静脉导管持续引流加胸腔注药治疗恶性胸腔积液，疗效好，副作用少，护理工作简便。     

中心静脉导管引流和常规胸腔穿刺控制恶性胸腔积液的比较

目的:观察中心静脉导管引流后注药治疗恶性胸腔积液的临床疗效。方法:将恶性胸腔积液患者随机分成两组,分别进行中心静脉导管闭式引流(引流组)和常规胸腔穿刺(常规组),并于胸腔内注入顺铂。结果:引流组胸腔积液的控制率为84.00%,明显优于常规组的57%(P<0.01),且不良反应少于常规组。结论:应用中心静脉导管装置引流恶性胸腔积液操作安全、简便,能最大限度地排净胸腔积液,对控制癌性胸腔积液有较好的疗效,能显著改善患者生活质量。     

高聚生联合顺铂治疗肺癌胸腔积液的临床疗效观察

目的：观察高聚生联合顺铂治疗肺癌胸腔积液的临床疗效。方法：将56例肺癌合并恶性胸腔积液患者随机分为治疗组和对照组，尽量抽尽胸腔积液至不易抽出为止，治疗组胸腔内注入高聚生＋顺铂，对照组胸腔内注入顺铂，3～5天重复用药一次，连用3～4次后观察疗效。结果：治疗组总有效率为82．14名，对照组总有效率为57．14老，两组比较差异有显著性（P〈O．05）。结论：高聚生联用顺铂治疗肺癌所致胸水疗效肯定、安全，是治疗肺癌所致胸水较好的方法之一，值得临床推广应用。     

Approach to the management of pleural effusion in malignancy

The diagnostic and therapeutic approaches to malignant pleural effusions are reviewed, and data on the retrospective study of 37 patients are presented with respect to diagnosis and management. All patients with stable effusions should be managed with systemic therapy for the primary tumor when an effective agent is available. When it becomes necessary to use local therapeutic measures, thoracostomy tube drainage with local instillation of tetracycline is recommended.     

Techniques for chest tube insertion and pleurodesis. An updated look at two common procedures

Chest tube insertion is warranted for drainage of large exudative pleural effusions, empyemas, hemothoraces, or chylothoraces, and for some pneumothoraces or parapneumonic effusions. Chest tubes may also be used to instill sclerosing agents to prevent recurrent malignant effusions or pneumothorax. There are no absolute contraindications to tube thoracostomy; however, if time allows, effort should be made to correct any coexisting hemorrhagic disorders before the procedure is performed. Pleurodesis may be contraindicated in patients who are expected to undergo lung surgery. The incisional method is safest for chest tube insertion and pleurodesis; bear in mind, however, that some patients with pneumothorax may be better treated with small-caliber drainage.     

微创置管胸腔引流与常规胸腔穿刺治疗恶性胸腔积液的效果观察

目的观察微创置管胸腔闭式引流与常规胸腔穿刺后注药治疗恶性胸腔积液的临床疗效。方法将58例恶性胸腔积液患者随机分成A（n=30）、B（n=28）2组,分别进行微创置管闭式引流和常规胸腔穿刺,并均于胸腔内注入化疗药物。结果A组胸腔积液控制的总有效率为83．3％,明显优于B组的57．1％（P〈0．05）。结论应用微创置管引流恶性胸腔积液操作安全、简便,能最大限度地排净胸腔积液,对控制癌性胸腔积液有较好的疗效,能显著改善患者生活质量。     

Pleural effusions caused by infection

Diagnostic thoracentesis is imperative when pneumonia is accompanied by an effusion (parapneumonic effusion). Examination of the pleural fluid is the only way to differentiate empyema and complicated parapneumonic effusions from uncomplicated parapneumonic effusions, and this differentiation is vital in deciding whether chest tube drainage is needed. If the aspirated pleural fluid contains pus or bacteria, closed chest tube drainage and antibiotic therapy should be started promptly. The same management approach is indicated if the pleural fluid pH is less than 7.00 or the glucose level is less than 40 mg/ml, since these effusions almost invariably are complicated parapneumonic effusions that do not resolve without fluid drainage. If the pleural fluid pH is greater than 7.20 and glucose level is more than 40 mg/ml, antibiotic therapy alone will suffice. Management of parapneumonic effusions with a pH of 7.00 to 7.20 should be based on serial observations of clinical status and pleural fluid findings.     

Malignant pleural effusions: pleurodesis using a small-bore percutaneous catheter

This study describes our experience using a percutaneously placed small-bore catheter for drainage of malignant pleural effusions and subsequent instillation of a sclerosing agent to obliterate the pleural space. We treated 15 consecutive patients with known metastatic cancer and a symptomatic pleural effusion. Twelve patients survived for more than four weeks after the procedure; 11 of these 12 patients had a successful objective clinical response. The procedure was well tolerated, with little or no discomfort during catheter placement and the maintenance period. No serious complications were encountered. We conclude that the use of a small-bore percutaneously placed "pneumothorax" catheter in the management of malignant pleural effusions is an effective and more comfortable alternative to large-bore closed-tube thoracostomy.     

高聚金葡素联合顺铂治疗恶性胸腔积液临床观察

目的观察高聚金葡素(简称金葡素)联合顺铂(DDP)胸腔内给药治疗恶性胸腔积液的近期疗效和不良反应。方法经病理学、细胞学证实的恶性胸腔积液47例,采用中心静脉导管行胸腔引流术排尽胸腔积液后,随机分为两组。治疗组(A组,n=27):采用胸腔内注入顺铂及金葡素制剂;对照组(B组,n=20):采用胸腔内注入顺铂。金葡素每次注入4000单位,顺铂每次注入60mg,每周注射1次,连续注射3周后复查。结果治疗组总有效率81.5%,对照组总有效率55.7%。治疗中不良反应主要为恶心、呕吐、发热和胸痛不适,治疗组不良反应发生率为46.1%,对照组为47.6%,两组差异无统计学意义(P0.05)。结论顺铂联合金葡素胸腔内灌注治疗恶性胸腔积液与单药顺铂比较,有较好的疗效,且不增加不良反应,值得临床推广使用。     

Pleural effusion: diagnostic value of measurements of PO2, PCO2, and pH

A review of the literature suggests that the measurement of the partial pressure of oxygen (PO2) and carbon dioxide (PCO2) and pH may provide additional diagnostic, therapeutic, and prognostic information in the management of pleural effusions. Parapneumonic effusions with a pH less than 7.2 indicate an impending empyema requiring tube thoracostomy in more than 98% of cases. A distinction between a tuberculous pleural effusion and a malignant pleural effusion of recent onset (less than two months) can frequently be made by measuring the pleural fluid pH. In 100% of reported cases, tuberculous pleural effusions have a pleural fluid pH less than 7.4, whereas over 60% of recent malignant effusions have a pleural fluid pH greater than 7.4. Generally, measurements of PO2 and PCO2 have little discriminatory value in determining cause or proper management of pleural effusions. It is recommended that proper anaerobic collection of pleural fluid for pH measurements be obtained routinely in all pleural effusions of unknown cause.     

Chest tubes: indications, placement, management, and complications

Use of tube thoracostomy in intensive care units for evacuation of air or fluid from the pleural space has become commonplace. In addition to recognition of pathological states necessitating chest tube insertion, intensivists are frequently involved in placement, maintenance, troubleshooting, and discontinuation of chest tubes. Numerous advances have permitted safe use of tube thoracostomy for treatment of spontaneous or iatrogenic pneumothoracies and hydrothoracies following cardiothoracic surgery or trauma, or for drainage of pus, bile, or chylous effusions. We review current indications for chest tube placement, insertion techniques, and available equipment, including drainage systems. Guidelines for maintenance and discontinuation are also discussed. As with any surgical procedure, complications may arise. Appropriate training and competence in usage may reduce the incidence of complications.