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目的胸腔置入引流管注入尿激酶后空针抽液(观察组)与自然引流(对照组)治疗包裹结核性胸膜炎疗效的比较。方法已形成包裹结核性胸膜炎患者72例,随机分成2组,观察组36例,对照组36例。两组患者均接受2H.R.Z.E/10H.R.E的口服抗痨方案,并予以胸腔穿刺置管,注入尿激酶20万IU 1次/d;观察组每次注药后2 h使用50ml空针于引流管接头处抽吸胸水至不能抽出为止,对照组注药后2 h开放引流袋自然引流胸水至不能流出为止。注药前及注药后分别测定胸水中D-二聚体的含量,记录胸水吸收的时间(彩超测定未见胸水或胸水深度<0.5cm),胸水引流量,观察不良反应的发生率。结果两组注药后D-二聚体的含量均较注药前显著升高(P<0.05)但观察组较对照组升高多,两组间差异有统计学意义(P<0.05)。胸水消失时间,观察组较对照组短,两组间差异有统计学意义(P<0.05)。胸水引流量两组间差异无统计学意义,不良反应主要为血性胸水、胸疼、高热,未见导管感染及气胸,两组间差异无统计学意义。结论胸腔内注入尿激酶后空针抽吸胸水治疗有包裹的结核性胸膜炎有明显疗效,可以缩短置管时间,同时不增加不良反应的发生率。
Objective To compare the therapeutic effect of empty needle needle drainage (observation group) with natural drainage (control group) in the treatment of tuberculous pleurisy after injecting urokinase into thoracic cavity. Methods A total of 72 patients with tuberculous pleurisy were enrolled. They were randomly divided into two groups: 36 cases in the observation group and 36 cases in the control group. Both groups received oral anti-tuberculosis 2HRZE / 10H.RE regimen, and thoracentesis and catheterization into urokinase 200,000 IU / d; observation group 2 h after each injection using 50ml empty needle in Drainage tube joint pumping pleural effusion can not be withdrawn so far, the control group 2 h after injection of drainage bag drainage of natural drainage of pleural effusion can not flow so far. The concentration of D-dimer in pleural fluid and the time of pleural fluid absorption (pleural effusion or pleural effusion depth <0.5cm) and drainage of pleural fluid were recorded before injection and after injection. The incidence of adverse reactions was observed. Results The content of D-dimer in both groups increased significantly (P <0.05), but the observation group increased more than the control group. The difference between the two groups was statistically significant (P <0.05). Pleural effusion disappeared, the observation group shorter than the control group, the difference between the two groups was statistically significant (P <0.05). There was no significant difference in pleural effusion between the two groups. Adverse reactions were mainly bloody pleural effusion, chest pain, hyperthermia, no catheter infection and pneumothorax. There was no significant difference between the two groups. Conclusion Intrapleural injection of urokinase after empty needle aspiration pleural effusion treatment of wrapped tuberculous pleurisy has a significant effect, can shorten the catheterization time, without increasing the incidence of adverse reactions.