尿激酶联合沙培林治疗多房性包裹性恶性胸腔积液

目的观察尿激酶联合沙培林治疗多房性包裹性恶性胸腔积液的临床效果及安全性。方法收集21例患有多房性包裹性恶性胸腔积液的患者,先经皮穿刺中心静脉导管胸腔置管引流,然后经导管注入尿激酶25万U后夹管4h以上后再次引流,共注药3～5次;待胸水基本引尽、肺复张后经导管注入沙培林10KE,去枕平卧后每10～15min转动体位,共翻身3圈,24h后再次引流,共注药2～3次。结果所有患者胸腔注入尿激酶后均能使胸水通畅、肺复张完全,有效率为100%。有5例（23.8%）患者出现一过性血性胸水颜色加深或原为非血性胸水变为血性胸水,无全身出血,有1例（4.8%）出现中度发热,治疗后1d热退。继而用沙培林后完全缓解（CR）16例（76.2%）,部分缓解（PR）3例（14.3%）,无效（NC）2例（9.5%）,胸水控制总有效率为90.5%,有14例（66.7%）出现低到中度发热,持续时间为2～10d,有5例（23.8%）出现轻度的胸痛,用新广片或吲哚美辛栓剂可控制。结论尿激酶联合沙培林治疗多房性包裹性恶性胸腔积液效果明显,不良反应轻微,值得临床推广应用。

Treatment of multilocular encapsulated malignant pleural effusion with urokinase combined with Sapylin

Objective To observe the clinical efficacy and safety of intrapleural injection of urokinase combined with Sapylin in treatment of multilocular encapsulated malignant pleural effusion. Methods Twenty-one cases of multilocular encapsulated malignant pleural effusion underwent firstly percutaneous puncture for introducing central venous catheter which was left in thoracic cavity for continuous drainage of pleural effusion,then transcatheter injection of urokinase 250000U which was reserved for over 4 h,and then drainage continued again. These procedures were repeated for 3-5 times. 10 KE of Sapylin was injected through the catheter into thoracic cavity after the pleural effusion was drained and the lung was reexpanded completely as far as possible. The patients bodies were rotateed every 10-15min in bed without pillows for a total of 3 cycles. The Sapylin was reserved for 24 h,then drainage continued again. The procedures of injec-tion of Sapylin were also repeated for 2-3 times. Results After injection of urokinase,the drainage could be easy and the lung could reexpand completely. The effective rate was 100% . Five cases（ 23. 8% ） had transi-ent bloody pleural effusion or the color of original bloody pleural effusion deepened,but no systemic bleeding. One case（ 4. 8% ） had moderate fever which subsided 1d after treatment. After injection of Sapylin,16 cases showed CR,3 cases PR,and 2 cases NC. Total effective rate of controlling pleural effusion was 90. 5% . Fourteen cases（ 66. 7% ） had low to moderate fever for 2-10 d,5 cases（ 23. 8% ） had mild chest pain whichwas controlled by Xingguangpian or indomethacin suppository. Conclusions Treatment of multilocular en-capsulated malignant pleural effusion with urokinase combined with Sapylin was obviously effective and had mild adverse reaction. It is worthy of clinical application.