有胸膜反应的结核性胸膜炎治疗方案选择与评估

目的探讨有胸膜反应的结核性胸膜炎患者的最佳治疗方案，评估术前30min肌注安定10mg，继续胸穿或中心静脉导管引流法的可行性及临床疗效。方法对126例有胸膜反应的结核性胸膜炎患者，按发生胸膜反应先后顺序随机分为三组。A组38例，中心静脉导管引流；B组46例，常规胸腔穿刺抽液每周2—3次；C组42例，规律抗结核治疗。三组患者的化疗方案均为2HRZE（S）／4HR，口服强的松30mg／d，治疗1个月和6个月后复查。结果A组1个月后胸腔积液控制率为97．4％，显效31例（81．6％），有效6例（15．8％），无效1例（2．6％），6个月后总有效率为100％；B组1个月后胸腔积液控制率为67．4％，显效4例（8．7％），有效27例（58．7％），无效15例（32．6％），6个月后总有效率为80．4％；c组1个月后胸腔积液控制率38．1％，显效3例（7．1％），有效13例（31％），无效26例（61．9％），6个月后总有效率42．8％。结论对有胸膜反应的结核性胸膜炎患者，采用术前肌注安定10mg后，给予中心静脉导管引流，疗效明显优于胸腔穿刺，胸腔穿刺优于保守治疗。

Assessment of treatment regimens in 126 cases of tuberculosis pleural effusion with pleural reaction

Objective To explore the best regimen of treatment for have pleural reaction tuberculosis pleural effusion,and to evaluate the efficacy and safety of in ject drug before surgery to continue aspiretion for pleural effusion and drainage in the thorax.Methods 126 cases of have pleural reaction tuberculosis pleurisy were divided into group A,B and C at random.A Aroup:38 cases put drainage in the thorax,B group:46 cases carry aspiration for pleural effusion two or three times of a week,C group:42 cases of regular antituberculosis treatment.Three groups all use 2 HRZE(S)/4 HR,and use pedison 30 mg/d.Results After one month the group A:controlling rate is 97.8%,31 cases(81.6%) have remarkable result,6 cases(15.8%) have effective result,1 Case(2.2%) has no effective,and tatal effective rate is 100% after 6 months;The group B:controlling rate is 67.4%,4 cases(8.7%) have remarkable result,27 cases(58.7%) have effective result,15 cases(32.6%) have no effective,and effective rate is 81.4% after 6 months.The group C:controlling rate is 38.1%,3 cases(7.1%) have remarkable result,13 cases(31%)have effective result,26 cases(61.9%) have no effective,and effective rate is 42.9% after 6 months.Conclusion To have pleural reaction of tuberculosis pleural pleural effusion,inject diazepam 10 mg 30 minutes before surgery,the drainage in the thorax is better than aspiration for pleural effusion obviously.The aspiration from pleural effusion is better than conservative treatment.