凝血酶和50%GS胸腔注入治疗难治性气胸的疗效观察

目的探讨凝血酶和50%GS胸腔注射用于治疗难治性气胸的临床疗效。方法选择我院2006年1月至2012年12月收治的难治性气胸患者87例,随机分为观察组(44例)和对照组(43例),两组患者在入院后即进行对症治疗及原发病的处理,对照组先行胸腔闭式引流,在X线片显示肺大部复张时给予胸腔注入50%葡萄糖(GS)40mL,观察组其基础上采用凝血酶1000IU+50%GS 40mL胸腔注入,比较两组患者的临床效果及不良反应情况。结果观察组注药次数、漏气终止时间、住院时间明显少于对照组,而有效率更高,两组差异具有统计学意义(P<0.05)。两组不良反应差异无统计学意义(P>0.05),经6个月至1年的随访,观察组复发1例(复发率2.3%),对照组复发3例(复发率7.0%),对照组复发率明显高于观察组(P<0.05),差异具有统计学意义。结论凝血酶和高渗葡萄糖联用治疗难治性气胸有效率达93.1%,与单用高渗葡萄糖相比,临床效果更为显著,复发率也有所降低,是治疗难治性气胸的有效手段。

Analysis of the Treatment of Intractable Pneumothorax with Combined Application of Thrombin and 50% GS

Objective To evaluate the effect of combined application of thrombin and 50% glucose to cure the intractable pneumothorax. Methods 87 patients with refractory pneumothorax were chosen from Jan 2006 to Dec 2012 in our hospital, and randomly divided into two groups, 44 patients in observation group and 43 patients in control group. The patients of two groups were treated according to symptoms and protopathy when hospitalized. Patients of control group were treated with closed thoracic drainage at first, injected with 40mL 50% glucose into thorax when the Xray chest radiograph indicated that most part of lung had recruited. While patients of observation group were injected with 1000IU thrombin and 40mL 50% glucose. Results The times of injection, the end time of air leakage and the hospital stays of observation group were obviously less than control group, while the effective rate was higher （P〈0.05）. The adverse reactions occurred between these two groups had no significant difference （P〉0.05）. After 6 to 12 months follow-up visits, 1 patient in observation group and 3 patients in control group relapsed, the recurrence rate between them had significant difference （P〉0.05）. Conclusion The combined application of thrombin and 50% glucose shows a higher effective rate （93.1%） and lower recurrence rate when compared with the use of 50% glucose alone, and can be an effective therapeutic method of intractable pneumothorax.