胸腔内应用滑石粉对恶性胸腔积液的治疗价值

目的探讨胸腔内应用滑石粉对恶性胸腔积液的治疗价值.方法44例恶性胸腔积液,在胸片或B超定位下行胸腔闭式引流,以每间隔2h释放200ml胸液的速度放尽胸水,采用滑石粉4g、生理盐水40ml、2%利多卡因5ml混合而成的悬液,通过引流管注入胸膜腔,夹闭引流管,让病人反复改变体位2h,恢复引流,至24h内胸液引流量<150ml时拔管.结果痊愈36例(81.8%),显效6例(13.7%),无效2例(4.5%),总有效率95.5%.并发症有胸痛21例(47.7%),发热24例(54.5%),呼吸窘迫1例,均可药物控制.结论以滑石粉行胸膜粘连,治疗恶性胸腔积液,操作简单,安全有效,值得临床推广.

INTRAPLEURAL TALC FOR THE TREATMENT OF MALIGNANT PLEURAL EFFUSION

Objective To evaluate the treatment of interapleural talc on the patients with malignant pleural effusion.Method There were 44 patients with malignant pleural effusion in the study.Every cases was inserted a chest drain to release the effusion with the rate of 200 ml per 2 hours.When there was no evidence of fluid in the pleural space as assessed by plain chest roentgenography,the talc slurry containing 4 g talc、40 ml of saline solution (0.9%) and 5 ml of 2% lidocaine was injected via the intercostal drain into the pleural space.An additional 20 ml of saline solution was used to flush the drain.Then,the drain was clamped,and the patient was asked to change position to allow adequate distribution of talc.After 2 hours,the drain was opened again.When the drainage decreased to less than 150 ml per 24 hours,the chest drain was removed.Result complete success was observed in 36 cases (81.8%),partial success in 6 cases (13.7%),and ineffective success in 2 cases (4.5%).There were 21 (47.7%) and 24 (54.4%) cases experienced pleuritic pain and fever after talc pleurodesis respectively,1 cases suffered from respiratory insufficiency which controled by using glucocorticoid later.Conclusion The talc pleurodesis is an effective treatment for the patients with malignant pleural effusion.It is safe and easily performed,and should be used extensively in clinic.