胸膜腔内注入尿激酶预防结核性渗出性胸膜炎所致胸膜肥厚和包裹性积液的研究

目的　探讨胸膜腔内注入尿激酶（urokinase,UK）对结核性渗出性胸膜炎所致胸膜肥厚和粘连包裹的影响。方法　81例收治的结核性粘连包裹性胸膜炎患者随机分为注药组(42例)和非注药组(39例)，注药组于每次抽液后注入尿激酶10万IU，其他治疗相同。结果　注药组抽液总量(3891±573)ml，而非注药组(3045±498)ml(P<0.01)，注药组胸膜厚度(1.10±0.20)mm，而非注药组(1.40±0.30)mm(P<0.01)，胸膜粘连发生率注药组10%，非注药组36%(P<0.01)，平均注药次数(4.6±1.4)(3～8)次。同时发现胸液消失时间略有延长，但同对照组相比差异无显著性。结论　胸膜腔内注入尿激酶能显著增加胸液引流量，能有效降低胸膜肥厚和粘连发生的机会和程度，与对照组相比差异有显著性。

The study of intrapleural urokinase in the prevention of pleural thickening and loculated effusions by tuberculous pleurisy

OBJECTIVE: To investigate the effects of intrapleural urokinase in the prevention of pleural thickening and loculated pleural effusions by tuberculous pleural effusion. METHOD: Eighty-one patients with tuberculous pleural effusion were randomized into 2 groups, intrapleural urokinase group (group I) and conventional group (group C). The patients in group I were injected with urokinase 100 000 IU intrapleurally after each thoracocentesis on twice a week basis, other therapies were similar to group C. RESULTS: The mean volume of fluid drained in group I was (3 981 +/- 573) ml, while it was (3 045 +/- 498) ml in group C (P < 0.01). The mean thickness of pleura in group I was (1.10 +/- 0.20) mm, but it was (1.40 +/- 0.30) mm in group C (P < 0.01), the incidence of pleural adhesion and location in group I was 10%, while it was 36% in group C (P < 0.01). The mean number of injection was (4.6 +/- 1.4) (ranged 3 approximately 8). The resolution time of pleural effusion was prolonged slightly, but there was no significant difference between two groups. CONCLUSION: Intrapleural urokinase can evidently increase the volume of pleural effusion drained and prevent pleural thickening and adhesion.