中心静脉导管胸腔置管引流联合尿激酶灌注治疗结核性胸腔积液的疗效

目的探讨中心静脉导管胸腔置管引流联合尿激酶灌注治疗结核性胸腔积液的临床疗效。方法将56例结核性胸腔积液患者按不同的治疗方法分为试验组32例和对照组24例。2组患者均采用抗结核药物及退热、对症治疗。并在彩色多普勒超声胸水定位后行中心静脉导管胸腔置管（选择最大、最深积液区进行置管）,置管后间断排放或负压抽吸胸腔积液（抽液量800～1 500 mL.次-1）。在每次放液结束后,试验组采用生理盐水20 mL＋尿激酶25万U配制成混合药液共20 mL,其中15 mL经中心静脉导管注入胸腔,5 mL用来封管;对照组采用生理盐水20 mL＋肝素钠2 500 U配制成混合药液共20 mL,其中15 mL经中心静脉导管注入胸腔,5 mL用来封管。2组疗程为7～14 d。结果试验组总有效率显著高于对照组（P〈0.05）。试验组胸腔积液引流量与对照组比较差异有统计学意义（P〈0.05）,试验组胸腔积液包裹、导管堵塞发生率均显著低于对照组（均P〈0.05）。结论中心静脉导管胸腔置管引流联合尿激酶灌注治疗结核性胸腔积液,引流较彻底,并发症少,是一种较理想的治疗方法。

Central Venous Catheter Chest Tube Drainage Combined with Urokinase Perfusion for Tuberculous Pleural Effusion

Objective To explore the clinical efficacy of central venous catheter chest tube drainage combined with urokinase perfusion in the treatment of tuberculous pleural effusion.Methods Fifty-six patients with tuberculosis pleural effusion were divided into experiment group（n=32） and control group（n=24） according to different treatment methods.All patients were given antituberculosis drugs and antipyretic and symptomatic treatment.Chest tube placement was performed using central venous catheters in the largest and deepest effusion areas after pleural fluid positioning by color Doppler ultrasound.Then pleural effusion was intermittently emitted or aspirated（800-1 500 mL per time）.After effusion emission,the experiment group was treated with a mixed solution of 20 mL normal saline and 250 000 U urokinase and the control group was given a mixed solution of 20 mL normal saline and 2 500 U heparin.Of the 20 mL mixed solution,15 mL solution was injected into the chest through central venous catheter and 5 mL solution was used to seal the tube.Patients were treated for 7-14 days.Results Compared with control group,the total effective rate significantly increased but the incidence of parcel pleural effusion and catheter blockage obviously decreased in experiment group（all P0.05）.In addition,the volume of drainage from the chest tube was statistically significant between the two groups（P0.05）.Conclusion Central venous catheter chest tube drainage combined with urokinase perfusion is an effective and ideal treatment for tuberculous pleural effusiont,with the advantages of thorough drainage and fewer complications.