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目的观察胸腔内置入中心静脉导管引流胸腔积液加胸腔内注入药物治疗大量胸腔积液的疗效。方法自2005年2月至2008年2月对各种原因引起的大量胸腔积液共37例患者经B超定位后,在无菌操作下将中心静脉导管置入胸膜腔,持续,缓慢,间歇地排尽胸腔积液。对结核性胸膜炎排尽胸腔积液后注入异烟肼注射液0.1～0.3g,地塞米松注射液5～10mg。对癌性胸腔积液患者胸腔内注入37～40℃生理盐水800～1000mL,胸腔内保留1h后充分排尽,继续化疗药物阿霉素40mg/㎡,顺铂40mg/㎡,氟脲嘧啶500mg/㎡,地塞米松注射液20mg注入胸腔,之后嘱患者不断交换体位,以利于药物与胸膜均匀接触。封管24h后持续引流至每日引流量少于50mL后撤管。对包裹性胸腔积液伴分隔者首次排尽胸腔积液后胸腔内注入0.9%生理盐水20～40mL加尿激酶10万单位,之后嘱患者不断交换体位,封管24～48h后打开中心静脉导管排放胸腔积液,复查B超如仍有分隔可再次注入尿激酶10万单位,并重复以上操作,直至每日引流量少于50mL后撤管。对以上方法处理仍反复大量胸腔积液者胸腔内注入斯奇康注射液10～20mL,以人为造成胸膜反映引起胸膜粘连,从而减少胸腔积液的产生。结果显效18例,占48.6%,有效16例,占43.2%,无效3例,占8.2%,总有效率91.9%。结论采用中心静脉导管胸腔置管引流加注药治疗大量胸腔积液具有创伤小,安全性好,易固定,疗效确切,副反应未见增加,操作方法简单易行,可随时胸腔内注入药物等优点;且能使患者生活质量明显提高。值得在基层医院推广应用。
Objective To observe the curative effect of pleural effusion treated by drainage of pleural effusion through central venous catheter and intrathoracic injection of drugs in the thoracic cavity. Methods From February 2005 to February 2008, a total of 37 patients with pleural effusion caused by a variety of reasons were placed in the pleural space under aseptic conditions after B-ultrasound, continuous, slow, intermittent Discharged to pleural effusion. Tuberculous pleurisy row pleural effusion after injection of isoniazid 0.1 ~ 0.3g, dexamethasone injection 5 ~ 10mg. Patients with pleural effusion of pleural effusion into the 37 ~ 40 ℃ saline 800 ~ 1000mL, 1h after the pleural cavity was fully drained to continue chemotherapy drug doxorubicin 40mg / ㎡, cisplatin 40mg / ㎡, fluorouracil 500mg / ㎡, dexamethasone injection 20mg injected into the chest, then Zhu Huanzhe constant exchange of position, in order to facilitate uniform drug and pleural exposure. 24h after sealing tube continuous drainage to the daily drainage less than 50mL after the withdrawal of the tube. On paroxysmal pleural effusion with separators for the first time to drain pleural effusion after intrathoracic injection of 0.9% saline 20 ~ 40mL plus urokinase 100,000 units, after Zhu Huanzhe constantly exchange of position, sealing tube 24 ~ 48h after opening the central venous catheter Effusion pleural effusion, the review of B-if there is still separated from the urokinase can be injected again 100,000 units, and repeat the above operation, until the daily drainage less than 50mL after the withdrawal of tubes. The above method is still dealing with a large number of pleural effusion were injected intrathoracic Si Ke Kang injection 10 ~ 20mL, induced by pleural reaction caused by pleural adhesions, thereby reducing the generation of pleural effusion. The results were effective in 18 cases, accounting for 48.6%, effective in 16 cases, accounting for 43.2%, 3 cases were ineffective, accounting for 8.2%, the total effective rate was 91.9%. Conclusion Central venous catheter pleural catheter drainage and injection of large amounts of pleural effusion with less trauma, safe, easy to fix, the exact effect, no increase in side effects, the operation method is simple, ready for intra-thoracic injection of drugs Advantages; And patients can significantly improve the quality of life. Worthy of promotion and application in primary hospitals.