微创胸腔闭式引流术与胸腔穿刺抽液治疗结核性胸腔积液的疗效对比

目的对比观察微创单腔导管进行胸腔闭式引流术与常规胸腔穿刺抽液治疗结核性胸腔积液的临床疗效。方法收集2008年12月至2012年12月在文登中心医院感染性疾病科住院的结核性胸膜炎患者共60例。患者在接受3HRZE/9HR正规口服抗结核治疗的同时,其中30例应用微创单腔静脉导管进行胸腔闭式引流,另30例采用常规胸腔穿刺抽液,对比观察两组发热消退时间、胸闷症状改善、胸水消失时间以及并发症的发生情况。结果应用微创单腔导管进行胸腔闭式引流术组,发热消失时间、胸闷症状改善时间、胸水消失时间分别为(4.7±1.4)、(1.4±0.3)和(4.10±1.31)d,而穿刺抽液组对应分别为(9.5±2.3)、(4.5±1.2)和(13.56±2.11)d,两组间比较差异均有统计学意义(P0.01)。在并发症方面,导管引流组3例(10%)出现胸膜增厚,1例(3.3%)出现包裹性胸腔积液,未发生血胸、气胸及胸膜反应;穿刺抽液组18例(60%)出现胸膜增厚,12例(40%)出现包裹性胸腔积液,血胸、气胸和胸膜反应各3例。两组各种并发症的发生率比较差异有统计学意义(P0.01)。结论采用微创单腔导管进行胸腔引流术治疗结核性胸腔积液症状改善快,并发症发生率低,患者依从性好,值得临床推广应用。

Comparative study of minimally-invasive closed drainage of pleural cavity and routine repeated thoracentesis in the treatment of tuberculous pleural effusion

Objective To eampare the effect of minimally-invasive closed drainage of pleural cavity by single lumen catheter and routine thoracentcsis in the treatment of tuberculous pleural effusion. Methods Sixty patients with tuberculous pleural effusion, who were treated in Wendeng central hospital from December 2008 to December 2012, were retrospectively investigated. In addition to routine antitubereulous regimen（3HRZ/9HR）, 30 patients with pleural effusion were treated by minimally-invasive dosed drainage of plcural cavity with single lumen catheter, while of the other 30 pleural effesion patients were treated by routine repeated thoracentesis. The time for resolution of fever, dyspnea and pleural effusion, and the occurrence ratio of complications, were compared between the two groups. Results The time for resolution of fever, dyspnea and pleural effusion were （4. 7 ＋ 1.4） d, （ 1.4 ＋0. 3） d and （4. 10 _＋ 1.31 ） d, respeetivly, in patients treated by minimally-invasive closed drainage. While in patients treated by routine repeated thoracentesis, the corresponding time were （9. 5 ＋ 2. 3） d, （4. 5 -＋ 1.2 ） d and （13.56 ＋ 2. 11 ） d, respectively, there were significant differece between the two groups（ P 〈 0. 01 ）. Compilcations were more common in patients who received routine repeated thoracentesis, including pleural thickening（60% ）, cystic hydrothorax （40%）, hemotho- rax （ 10% ）, pneumothorax （ 10% ） and pleura reaction （ 10% ）. In contrast, only few complications were observed in few pa- tients who received closed drainage, such as pleural thickening（ 10% ） and cystic hydrothorax （3.3%）. Conclusion In the treatment of tuberculous pleural effusion, minimally-invasive closed drainage by single lumen catheter is an effective method with low ratio of complications, which can increase the compliance of patients and is worthy of further popularizing.