目的 比较不同化疗方案治疗结核性胸膜炎的效果.方法 135例结核性胸膜炎患者完全随机分为2组.治疗组68例,男45例,女23例,平均年龄(41±18)岁,胸膜腔积液(1410±1385)ml,行2HRZE/4HR方案治疗.对照组67例,男46例,女21例,平均年龄(42±16)岁,胸膜腔积液(1263±1156)ml,行4HRZE/2HR方案治疗.2组均行胸膜腔穿刺抽液,胸膜腔中等量和大量积液者使用中心静脉导管胸膜腔内置管引流,并加用泼尼松治疗4～8周.结果 治疗组治愈38例,治愈率55.9%;对照组治愈52例,治愈率77.6%,2组差异有统计学意义(P＜0.01).治疗组与对照组疗程均延长到12个月,治疗组累计治愈率75.1%(51例),对照组累计治愈率95.5%(64例)(P＜0.01).结论 2HRZE不能治愈近半数结核性胸膜炎,临床应根据患者病情制订化疗方案,在完成2个月强化期化疗后依据患者病情决定是否延长强化疗程.完成6个月治疗后,具体考虑是否延长到12个月疗程.%Objective To observe different chemotherapies in the treatment of tuberculous pleurisy results.Methods Totally 135 patients with tuberculous pleurisy were divided into two groups: treatment group (68 cases)and control group( 67 cases). Both groups underwent pleural puncture fluid, pleural effusion, prednisone and central venous catheter drainage plus pleural catheter drainage. The therapy lasted from 4 to 8 weeks. Results In the treatment group,38cases were cured and the cure rate was 55.9%. In the control group,52 cases were cured and the cure rate was 77.6%. At 12 months, the total cure rate of treatment rate was 75.1% (51) and the total cure rate of control rate was 95.5% (64) ( P ＜ 0.01 ). Conclusion The short-course chemotherapy of two months cannot cure nearly half of tubercular pleurisy patients. The chemotherapy plan should be decided according to patient' s condition after a two-month reinforcement chemotherapy period. By the end of six-month course, An extension of 12- month course should be considered at the end of the 6 months' therapy.
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