α1-receptor blockers combined with acupuncture treatment efficacy analysis of elderly patients with acute urinary retention

Objective To explore acupuncture and al-receptor blocker treatment efficacy of elderly patients with acute urinary retention. Methods Use of forward-looking monitoring and retrospective survey methodology, Choose January 1,2006 to January 1,2009 of acute urinary retention in 82 cases of elderly inpatients,Chronological order according to treatment group,39 cases were divided into control group,43 cases; Transurethral catheterization in both groups, stay catheter. The control group was treated with α1-receptor blocker hytrin (terazosin) and the application of antibiotics; the treatment group based on the above plus acupuncture therapy. Results The treatment group was 94.87% in the control group response rate was 76.74%, the two groups,P<0.05, the difference was significant. Conclusion al-receptor blockers combined with acupuncture treatment of elderly patients with acute urinary retention al-receptor blocker than simply good effects, synergistic effect, shortening the indwelling catheter time, avoid repeated urinary catheterization and reduce hospital infection, worthy to be popularized.     

α1-receptor blockers combined with acupuncture treatment efficacy analysis of elderly patients with acute urinary retention

Objective To explore acupuncture and al-receptor blocker treatment efficacy of elderly patients with acute urinary retention. Methods Use of forward-looking monitoring and retrospective survey methodology, Choose January 1,2006 to January 1,2009 of acute urinary retention in 82 cases of elderly inpatients,Chronological order according to treatment group,39 cases were divided into control group,43 cases; Transurethral catheterization in both groups, stay catheter. The control group was treated with α1-receptor blocker hytrin (terazosin) and the application of antibiotics; the treatment group based on the above plus acupuncture therapy. Results The treatment group was 94.87% in the control group response rate was 76.74%, the two groups,P<0.05, the difference was significant. Conclusion al-receptor blockers combined with acupuncture treatment of elderly patients with acute urinary retention al-receptor blocker than simply good effects, synergistic effect, shortening the indwelling catheter time, avoid repeated urinary catheterization and reduce hospital infection, worthy to be popularized.     

奈维在胸腔镜肺大泡切除术后防止漏气的临床疗效

Objective To explore the clinical efficacy of NEOVEIL in postoperative pulmonary air leakage of pulmonary bullae resection by video-assisted thoracic surgery. Methods We retrospectively analyzed clinical data of 37 cases received NEOVEIL combined with ATB45 in video-assisted thoracic surgery (the NEOVEIL group), and clinical data of 40 cases by ATB45 alone(the control group) . We compared postoperative hospitalization time, keeping time of pleural cavity tubes, the pulmonary leakage time and the incidence of pulmonary infection in the two groups. Results There was no postoperative mechanical ventilation,hemothorax and death. In the NEOVEIL group, the postoperative hospitalization time was 5 to 9 days, the postoperative keeping time of pleural cavity tubes 2 to 4 days, the postoperative pulmonary leakage time 0 to 2 days with 4 patients un-leakage, and 1 patients with pulmonary infection; whereas the postoperative hospitalization time was 6 to 10 days,the postoperative keeping time of pleural cavity tubes 3 to 6 days,the postoperative pulmonary leakage time 2 to 5 days and 8 patients with pulmonary infection in the control group. There was statistical significance in the postoperative hospitalization time, keeping time of pleural cavity tubes, the pulmonary leakage time and the incidence of pulmonary inflammation in two groups(P ＜ 0. 05). The incidence of pulmonary inflammation of the NEOVEIL group (2. 7%) was significantly lower than that of the control group(20. 0%)(x2 = 4. 02, P ＜ 0. 05). Conclusion The operative effectiveness of the NEOVEIL group is better than that of the control group. The NEOVEIL can prevent the postoperative pulmonary leakage.     

危重患者胸腔积液超声测量新方法的建立与应用

目的 探索危重患者胸腔积液超声精确测量的新方法 .方法 选择收住急诊ICU的危重患者46例,应用超声在平卧位、呼气末测定胸腔积液的高度(H)、中间层积液的面积(S)和在后背正中线、腋后线处的厚度(T1、T2),以H×S估算胸腔积液量(Vc),胸腔置管充分引流获取实际积液量.分析胸腔积液实际量与积液高度、厚度、面积及估算量的相关性,比较不同指标和方法 估算积液量的准确性.结果 在总组和各亚组中,胸腔积液实际量与S、(H和S)、Vc的相关性明显好于T1、T2和H.超声测量新方法 获取的估算量与实际积液量有较好的相关性(r=0.778,P＜0.001),而且非常接近实际积液量(平均相差56 ml),尤其在积液量＜500 ml时两者的差别无统计学意义[(417±94)ml对(402±95)ml,t=1.095,P=0.285].Logistic逐步回归分析和受试者工作特征曲线(ROC)分析均表明,以H、S、T1、T2预测实际积液量＞500 ml、400 ml和300 ml,其中以S最为可靠,其阈值分别为30.3 cm2、28.3 cm2和23.1cm2,相应的敏感性和特异性分别为0.77和0.88,0.72和1.0,0.95和1.0.结论 基于积液面积测定基础上建立的胸腔积液超声新测量方法 较传统方法 更可靠和精确,具有重要的临床价值,且测定技术简单,值得推广应用.

Abstract：

Objective To develop a new method to measure pleural effusion volume by ultrasound in critically ill patients. Methods Forty-six critically ill patients admitted to emergency ICU were involved.The height of effusion (H),area of effusion at the middle section (S), thickness of effusion at middle-back line (T1) and posterior axillary line (T2) were measured by ultrasound in supine position at the end of expiration. The measured volume of pleural effusion (Vc) was calculated by H×S,and the actual volume of drainage (V) within 2 hours was also recorded. The correlation of actual volume of pleural effusion (V)with effusion height (H) ,thickness (T1, T2), area (S) and the calculated volume (Vc) were analyzed to decide the most accurate index and method. Results There was much better correlation between actual volume of effusion and S, (H & S), Vc, than these between V and T1 ,T2, H in all patients and subgroup, Vc had good correlation with V and very close to V(the average difference was 56 ml) when the actual volume was less than 500 ml,there was no difference[(417 ± 94)ml vs (402±95)ml, t = 1.095, P = 0. 285]. Both Logistic regression analysis and receiver operating characteristic (ROC) curve showed S was the most reliable index to predict the actual volume to exceed 500 ml,400 ml,and 300 ml when compared with H,S,T1 and T2. The corresponding threshold was 30.3 cm2 , 28.3 cm2 and 23. 1 cm2 , with the sensitivity and specificity of 0. 77 and 0. 88,0.72 and 1.0,0.95 and 1.0, respectively. Conclusions This new method based on measuring the area of effusion by ultrasound is more efficient and reliable than those traditional ones to measure the volume of pleural effusion. It's clinically valuable and easy to perform, and deserves broad application.     

高频电深部热疗配合胸腔内注射顺铂及沙培林治疗恶性胸腔积液

目的 探讨高频电深部热疗配合A型链球菌制剂及顺铂胸腔注射治疗恶性胸腔积液的效果与耐受性.方法 将符合入组条件的158例恶性胸腔积液患者按随机数字表法分为观察组和对照组,2组均先用中心静脉导管行胸腔闭式引流,并根据原发肿瘤情况决定是否给予全身化疗.对照组闭式引流胸水后于胸腔内注射顺铂40～60 mg及A型链球菌制剂沙培林0.5 mg,每周1次,最多用4次.观察组在胸腔内注射药物(同对照组)后30～60 min给予1次患侧胸腔区域高频电深部热疗,热疗温度40.0～43.5 ℃,间隔3 d后再单独进行1次热疗,每次60 min,每周2次.比较2组的疗效、生活质量评分及毒性反应.结果观察组与对照组有效率分别为90.7% 和79.5%,差异有统计学意义(P＜0.05);Ⅰ+Ⅱ度毒性反应比较,差异无统计学意义(P＞0.05),2组患者均未出现Ⅲ度及以上毒性反应;2组治疗后生活质量评分均较治疗前明显改善(P＜0.05),组间差异无统计学意义(P＞0.05).结论 高频电深部热疗配合A型链球菌制剂及顺铂胸腔内注射,能提高恶性胸腔积液的疗效,改善患者的生活质量,而不增加毒性反应.

Abstract：

Objective To evaluate the toxicity and efficacy of thermotherapy used with a streptococcus A preparation (OK-432) and cisplatin for treating malignant pleural effusion (MPE),and to assess patients' tolerance.Methods A total of 158 MPE patients were randomized into experimental and control groups.Closed drainage of the thoracic cavity was conducted with all the patients using a central venous catheter,and systematic chemotherapy was administered individually on the basis of each patient's condition.Patients in the control group were treated with intrapleural administration of OK-432 (0.5 mg) and cisplatin (40-60 mg) weekly for a maximum of 4 weeks,while those in the experimental group were given 60min of high frequency electrical thermotherapy 30-60 min after the administration of the drugs.The thermotherapy was at 40-43.5 ℃ and administered twice a week.Efficacy,quality of life and toxicity were compared between the two groups.Results The overall response rate in the experimental and control groups was 90.6% and 79.5% respectively;and grade I-II toxicity was similar.No grade Ⅲ or more serious toxicity was observed.The life quality scores in both groups were significantly improved after treatment.Conclusions Thermotherapy combined with intrapleural OK-432 and cisplatin can improve the effectiveness of therapy and life quality in MPE patients without increased toxicity.     

CT引导下胸腔置管引流冲洗治疗复杂性肺炎旁胸腔积液24例

肺炎旁胸腔积液(parapneumonic effusion,PE)是肺炎常见的并发症,约40%的住院肺炎患者可并发肺炎旁胸腔积液[1].若是复杂性肺炎旁胸腔积液(complicated parapneumonic effusion,CPE)临床采用传统的全身治疗,疗程长,疗效常常不令人满意,且大多影响肺功能,病死率亦较高,我院1996年1月至2006年12月对住院的44例CPE,在全身治疗同时加用CT引导下胸腔置管引流冲洗治疗,收到了显著疗效,现报告如下.     

Removal of biofilm is essential for long-term ventilation tube retention

BACKGROUND Although long-term retention of a ventilation tube is required in many ear diseases,spontaneous removal of conventional ventilation tube is observed in patients within 3 to 12 mo.To address this issue,we aimed to determine a new method for long-term retention of the ventilation tube.AIM To explore the value of removing the biofilm for long-term retention of tympanostomy ventilation tubes.METHODS A case-control study design was used to evaluate the safety and effectiveness of long-term tube retention by directly removing the biofilm(via surgical exfoliation)in patients who underwent myringotomy with ventilation tube placement.The patients were randomly divided into two groups:Control group and treatment group.Patients in the treatment group underwent regular biofilm exfoliation surgery in the clinic,whereas those in the control group did not have their biofilm removed.Only conventional ventilation tubes were placed in this study.Outcome measures were tube position and patency.Tube retention time and any complications were documented.RESULTS Eight patients with biofilm removal and eight patients without biofilm removal as a control group were enrolled in the study.The tympanostomy tube retention time was significantly longer in the treatment group(43.5±26.4 mo)than in the control group(9.5±6.9 mo)(P=0.003).More tympanostomy tubes were found to be patent and in correct position in the treatment group during the follow-up intervals than in the control group(P=0.01).CONCLUSION Despite the use of short-term ventilation tubes,direct biofilm removal can be a well-tolerated and effective treatment for long-term tube retention of tympanostomy ventilation tubes in patients who underwent myringotomy.     

Effect of low-dose glucocorticoid on corticosteroid insufficient patients with acute exacerbation of chronic obstructive pulmonary disease

BACKGROUND: This study aimed to investigate the prevalence rate of critical illness-related corticosteroid insuffi ciency(CIRCI) and the effect of low-dose glucocorticoid on prognosis of CIRCI in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).METHODS: Since January 2010 to December 2012, 385 patients, who met the criteria of AECOPD, were enrolled in the Intensive Care Unit(ICU) of the First People's Hospital and Municipal Central Hospital of Xiangtan City. The AECOPD patients complicated with CIRCI screened by an adrenalcorticotrophic hormone test within 12 hours after admission to ICU were divided into a treatment group(n=32) and a control group(n=31) for a prospective, randomized and controlled clinical trial. Hydrocortisone(150 mg/d) or normal saline was injected intravenously for 7 days. The patients were followed up for 28 days after injection. The endpoint included 28-day survival time, non-shock time, ICU stay and the period of non-mechanical ventilation. The markers ofinfl ammation C-reactive protein, tumor necrosis factor-α, interleukin 6 and procalcitonin were measured at baseline and 7 days after treatment. The variables were analyzed by Student's t test, the non-parametric statistical test, the Chi-square test or the Kaplan-Meier method with SPSS18.0 statistic software. A P value 0.05 was considered statistically signifi cant.RESULTS: Totally 63 patients were diagnosed with CIRCI by an adrenalcorticotrophic hormone test and the prevalence rate was 16.4%. The shock rate of the AECOPD patients complicated with CIRCI was higher than that of the AECOPD patients without CIRCI(23.8% vs. 8.7%, P0.01). KaplanMeier analysis revealed that the 28-day survival time of the treatment group was obviously longer than that of the control group(P0.05). Compared with the control group, shock-free days within 28 days was longer in the treatment group(18.2±9.5 vs. 25.8±4.1, P0.05). Treatment with low-dose glucocorticoid obviously decreased the markers ofinfection and inflammation(P0.01), such as C-reactive protein(13.2±5.5 mg/L vs. 8.3±3.1 mg/L for the control group; 13.5±5.9 mg/L vs. 5.1±2.3 mg/L for the treatment group), tumor necrosis factor-α(26.1±16.2 g/L vs. 17.5±11.7 g/L for the control group; 25.0±14.8 g/L vs. 10.4±7.8 g/L for the treatment group) and procalcitonin(3.88 g/L vs. 2.03 g/L for the control group; 3.77 g/L vs. 1.26 g/L for the treatment group). Furthermore, the markers in the treatment group decreased more obviously than those in the control group(P0.01).CONCLUSION: The prevalence rate of CIRCI was higher in the patients with AECOPD in the department of critical medicine, and low-dose glucocorticoid treatment for one week reduced the 28-day mortality, shock time and markers ofinfection and infl ammation.     

拔尿管前行膀胱冲洗对开颅术后患者的影响

Objective To discuss the influence of bladder irrigation before pulling out catheter on the patients after craniotomy. Methods One hundred conscious patients after craniotomy were randomized into the experimental group and control group, each with 50cases. The experimental group was given bladder irrigation by 0.02% liquor nitrofurazoni then pulling out uric catheter after filling of bladder, the control group was pulled out uric catheter by routine method, the first micturition time after pulling out uric catheter of the two groups were observed and compared. Results Forty eight cases of the experimental group and thirty nine cases of the control group can micturate by themselves, there was significantly different between the two groups (P＜0.01). The first micturition time of the experimental group was (2.5±1.09) h while the control group was (3.31±1.35) h, there was significantly different between the two groups (P＜0.01) . Conclusions Bladder irrigation before pulling out uric catheter after craniotomy can promote the micturition early and favorably, avoid the elevation of blood pressure effectively, prevent the uroschesis, reduce the urethral infection and other complications, with important meaning to promote the rehabilitation of the patients.     

拔尿管前行膀胱冲洗对开颅术后患者的影响

Objective To discuss the influence of bladder irrigation before pulling out catheter on the patients after craniotomy. Methods One hundred conscious patients after craniotomy were randomized into the experimental group and control group, each with 50cases. The experimental group was given bladder irrigation by 0.02% liquor nitrofurazoni then pulling out uric catheter after filling of bladder, the control group was pulled out uric catheter by routine method, the first micturition time after pulling out uric catheter of the two groups were observed and compared. Results Forty eight cases of the experimental group and thirty nine cases of the control group can micturate by themselves, there was significantly different between the two groups (P＜0.01). The first micturition time of the experimental group was (2.5±1.09) h while the control group was (3.31±1.35) h, there was significantly different between the two groups (P＜0.01) . Conclusions Bladder irrigation before pulling out uric catheter after craniotomy can promote the micturition early and favorably, avoid the elevation of blood pressure effectively, prevent the uroschesis, reduce the urethral infection and other complications, with important meaning to promote the rehabilitation of the patients.     

类肺炎性胸腔积液68例临床分析

目的 总结类肺炎性胸腔积液的临床特征及治疗。 方法 对我院收治的68例类肺炎性胸腔积液的临床资料进行回顾性分析,根据辅助检查及实验室检查等,将类肺炎性胸腔积液分成单纯性类肺炎性胸腔积液（uncomplicated parapneumonic effusion,UCPE）及复杂性类肺炎性胸腔积液(complicated parapneumonic effusion,CPE)。比较其临床特点、治疗方法及预后。 结果 68例类肺炎性胸腔积液中,UCPE 51例, CPE 17例。类肺炎性胸腔积液以发热、咳嗽、胸痛为主要临床特点,与单纯肺炎症状相同。复杂性类肺炎性胸腔积液其发热时间较单纯性类肺炎性胸腔积液长,毒血症状重,白细胞计数高,胸水量大。51 例UCPE中,43例经全身应用抗生素治疗治愈,胸水量少不宜定位未能抽取胸水自行吸收、临床症状消失。8例经全身应用抗生素治疗+胸腔穿刺抽液1~2次而治愈;17例CPE中,经抗生素治疗+胸腔穿刺2次或以上者5例,胸腔闭式引流胸水者12例;10例治愈;7例临床症状好转、胸水明显减少出院、随访3月,其中3例胸水完全吸收,2例失访, 2例死亡。复杂性类肺炎性胸腔积液往往多见于年龄大、使用激素等免疫抑制剂及有基础疾病者或就医比较晚者。 结论 区分类肺炎性胸腔积液的分型对治疗相当重要、胸部X线或CT加B超检查可作为首先的检查方法,尽早胸腔穿刺抽取胸水或微管引流胸水,可减少患者发热时间、缩短病程,减少住院天数,明显提高治愈率。     

Ultrasound-guided pigtail catheters for drainage of various pleural diseases

Objective

Little is known about the efficacy and safety of ultrasound-guided pigtail catheters for the management of various pleural diseases in the emergency department, ward, and intensive care unit.

Methods

We conducted a retrospective study in a university hospital during a 1-year interval.

Results

A total of 276 patients (178 men and 98 women) underwent 332 pigtail catheters (the drain size ranged from 10F to 16F) under ultrasound guidance. The mean ± SEM patient age was 59 ± 18 years, and mean duration of drainage was 6.1 ± 2 days. A total of 64 drains (19.2%) were inserted for pneumothoraces; 98 drains (29.5%), for malignant effusions; 119 drains (35.8%), for parapneumonic effusions/empyemas; and 38 drains (11.4%), for massive transudate pleural effusions. The overall success rate was 72.9%. The success rate was highest when the drain was used to treat massive transudate effusions (81.6%) and malignant pleural effusions (75.5%), followed by parapneumonic effusions/empyemas (72.2%), hemothoraces (66.6%), and pneumothoraces (64.0%). Only 10 (3.0%) drains had complications due to the procedure, including infection (n = 4, 1.2%), dislodgment (n = 4, 1.2%), wound bleeding at the pigtail catheter puncture area complicated with hemothoraces (n = 1, 0.3%), and lung puncture (n = 1, 0.3%). There was no significant difference in success rate when different catheter sizes were used to treat pleural diseases.

Conclusions

Ultrasound-guided pigtail catheters provide a safe and effective method of draining various pleural diseases. We strongly suggest that ultrasound-guided pigtail catheters be considered as the initial draining method for a variety of pleural diseases.     

ARROW中心静脉导管在肝癌病人合并胸腔积液引流中的应用及护理

[目的]探讨ARROW单腔中心静脉导管在肝癌病人合并胸腔积液引流中的应用及护理。[方法]对62例肝癌病人合并胸腔积液需行胸腔穿刺放液的病人应用ARROW中心静脉导管代替传统的胸腔穿刺放液、抽液,观察其疗效、并发症,并对整个细致有效的护理过程进行总结。[结果]本组62例病人均1次置管成功,导管留置时间为3d～21d,未发生导管相关性感染、导管阻塞及导管脱出等并发症,置管引流后胸腔积液逐渐减少,病人呼吸困难、胸闷、心悸、气促、咳嗽等症状明显改善,病情得到缓解。[结论]本组应用ARROW单腔中心静脉导管引流胸腔积液,无继发感染、血气胸等并发症发生,做好穿刺点的护理,预防感染是保证置管引流成功的关键。     

Application of ultrasound-guided pigtail catheter for drainage of pleural effusions in the ICU

Background  Little is known about the effectiveness of the pigtail catheter for drainage of pleural effusions in the intensive care unit (ICU). Methods  We conducted a retrospective review of adult patients (≥18 years) who underwent ultrasound-guided pigtail catheter drainage of pleural effusions in the ICUs from January 2005 to July 2007 in a university hospital. Results  Among the 133 enrolled patients, there were 93 (70%) males and 40 (30%) females, with a mean age of 63.7 ± 15.4 years old. The reasons for pigtail drainage were as follows: thoracic empyema (n = 59, 44%), massive transudative pleural effusions (n = 33, 25%), postoperative pleural effusion (n = 29, 15%), malignant pleural effusion (n = 18, 14%) and traumatic hemothorax (n = 3, 2%). In comparing the total amount of fluids drained, the duration of drainage, success rate and complication rate among these different causes of pleural effusion, pigtail drainage for massive transudative pleural effusion yielded the largest amount of pleural fluids (5,382 ± 4,844 ml), provided the longest duration of drainage (9 ± 7 days), and had the highest complication rate (18%). The success rate was highest when used to treat traumatic hemothorax (100%) and postoperative pleural effusions (85%); drains inserted for empyema were more likely to fail (overall success rate, 42%). No significant insertion complications, such as hollow organ perforation, were caused by this procedure. Conclusion  The ultrasound-guided pigtail catheter inserted by intensivists is a well-tolerated and effective method of draining all kinds of pleural effusions in critically ill patients. We suggest that pigtail catheter drainage be considered as the initial treatment of choice in the ICU.     

超声引导BD套管针在胸腔积液抽吸治疗中的应用

目的 探讨超声引导BD套管针在胸腔积液抽吸治疗中的应用价值.方法 在超声引导下应用16G BD套管针,运用经皮穿刺技术,对238例不同性质的胸腔积液患者行抽吸液体、冲洗、注射药物、置管引流等操作共297次.结果 297次穿刺均一次成功,与超声引导普通金属套管针穿刺情况相比较,一次性穿刺成功率及治疗有效率明显提高,无气胸、血胸、复张性肺水肿等严重并发症发生.结论 超声引导下应用BD套管针经皮穿刺抽吸治疗胸腔积液较超声引导普通金属套管针更简便、安全、高效,值得推广应用.     

应用中心静脉导管引流结核性胸腔积液病人的护理

[目的]探讨应用中心静脉导管引流结核性胸腔积液的效果及中心静脉导管的护理。[方法]对78例结核性胸腔积液病人进行穿刺置管并多次使用闭式引流治疗,经过术前、术中、术后、胸腔内注射药物及拔管等精心护理。[结果]本组病例均一次置管成功,胸腔积液完全引出、吸收,病人症状缓解,导管留置时间4d～30d,无一例发生气胸、血胸、感染及其他并发症。[结论]应用中心静脉导管行胸腔闭式引流术引流方便,细致周到的护理是保证置管引流成功的重要措施。     

留置中心静脉导管治疗恶性胸腔积液的护理

目的 探讨留置中心静脉导管治疗恶性胸腔积液的整体护理经验.方法 对60例患者施行中心静脉导管胸腔留置并定时注入化疗药物治疗恶性胸腔积液.结果 恶性胸腔积液治疗有效率达95%.结论 留置中心静脉导管是目前治疗恶性胸腔积液最有效的方法之一,在留置中心静脉导管过程中通过施行术前、术中和术后的整体护理,可显著减少副作用和并发症的发生,改善患者的临床症状.     

超声引导穿刺抽液并注入尿激酶治疗结核性多房性胸腔积液

目的观察尿激酶对结核性多房性胸腔积液的治疗作用。方法在内科常规方案治疗下,对22例结核性多房性胸腔积液患者穿刺抽液并在胸膜腔内注入100,000IU尿激酶（用40ml生理盐水稀释）,另外20例患者常规抗结核治疗及行胸膜腔穿刺抽液治疗作对照。24小时后,再次超声引导下抽液,并记录首次注药前后的抽液量、壁层胸膜厚度、纤维素分隔积分。结果治疗组与对照组相比,用药后抽液量增多、胸膜厚度变薄、纤维素分隔减轻（P〈0．05）。结论胸膜腔穿刺引流并注入尿激酶能促进胸水引流,减轻胸膜肥厚、粘连,疗效肯定。     

Association between inflammatory mediators and the fibrinolysis system in infectious pleural effusions

The response of the fibrinolytic system to inflammatory mediators in empyema and complicated parapneumonic pleural effusions is still uncertain. We prospectively analysed 100 patients with pleural effusion: 25 with empyema or complicated parapneumonic effusion, 22 with tuberculous effusion, 28 with malignant effusion and 25 with transudate effusion. Inflammatory mediators, tumour necrosis factor-alpha (TNF-alpha), interleukin-8 (IL-8) and polymorphonuclear elastase, were measured in serum and pleural fluid. Fibrinolytic system parameters, plasminogen, tissue-type plasminogen activator (t-PA) and urokinase PA, PA inhibitor type 1 (PAI 1) and PAI type 2 concentrations and PAI 1 activity, were quantified in plasma and pleural fluid. The Wilcoxon signed-rank test was used to compare plasma and pleural values and to compare pleural values according to the aetiology of the effusion. The Pearson correlation coefficient was used to assess the relationship between fibrinolytic and inflammatory markers in pleural fluid. Significant differences were found between pleural and plasma fibrinolytic system levels. Pleural fluid exudates had higher fibrinolytic levels than transudates. Among exudates, tuberculous, empyema and complicated parapneumonic effusions demonstrated higher pleural PAI levels than malignant effusions, whereas t-PA was lowest in empyema and complicated parapneumonic pleural effusions. PAI concentrations correlated with TNF-alpha, IL-8 and polymorphonuclear elastase when all exudative effusions were analysed, but the association was not maintained in empyema and complicated parapneumonic effusions. A negative association found between t-PA and both IL-8 and polymorphonuclear elastase in exudative effusions was strongest in empyema and complicated parapneumonic effusions. Blockage of fibrin clearance in empyema and complicated parapneumonic effusions was associated with both enhanced levels of PAIs and decreased levels of t-PA.     

采用中心静脉导管引流治疗胸腔积液的临床研究

目的观察利用中心静脉导管进行胸腔置管引流术间断引流控制胸腔积液的疗效及优缺点。方法 98例结核性胸腔积液患者随机分为两组,50例采用中心静脉导管进行胸腔置管引流为研究组,48例行常规胸腔穿刺抽液为对照组,对两组患者的人均胸腔穿刺次数、平均每次手术所需时间、胸腔积液消失时间、平均住院天数、人均专项治疗费用、及穿刺不良事件人均发生率等方面进行观察和比较。结果研究组的人均胸腔穿刺次数、平均每次手术所需时间、胸腔积液消失时间、平均住院天数、人均专项治疗费用、及穿刺不良事件人均发生率均较对照组少,两组比较差异有显著性(P<0.05),两组病例穿刺不良事件发生率比较差异无显著性,但两组不良事件人均发生率比较差异有显著性。结论以中心静脉导管行胸腔置管引流是治疗胸腔积液安全、简便、有效的方法,值得临床推广。