闭式引流联合尿激酶治疗结核性包裹性胸腔积液临床疗效观察

摘要

Objective To investigate the clinical effect of closed thoracic drainage combined with urokinase in treatment of encapsulated tuberculous pleural effusion.Methods One hundred and four patients with encapsulated tuberculous pleural effusion treated in our hospital from February 2006 to March 2012 were randomly divided into the experimental group and the control group,with 52 patients in each group.The experimental group applied closed thoracic drainage combined with urokinase therapy,while the control group was only treated by closed thoracic drainage.Time for the disappearance of pleural effusion,the amount of protein in pleural effusion,leukocyte concentration,length of hospital stay,pleural thickness and clinical efficacy were compared between the two groups after treatment.Results After treatment,the total effective rate was 88.4％ in the experimental group,significantly higher than that in the control group (67.3％),P＜0.05.The amount of protein in pleural effusion,leukocyte concentration in the experimental group were significantly decreased after treatment than before treatment,with statistically significant difference (P＜0.05),while that in the control group showed no statistically significant difference before and after treatment (P＞0.05).In the experimental group,the pleural effusion disappeared (6.2±1.2) days after treatment and the length of hospital stay was (10.5±5.5) days,both significantly shorter than those in the control group,Three months after treatment,the pleural thickness was (1.5±0.5) mm,significantly less than that in the control group (P＜0.05).Conclusion For patients with encapsulated tuberculous pleural effusion,closed thoracic drainage combined with urokinase can quicken the absorption,reduce pleural adhesion,decrease complications,shorten the length of hospital stay,and improve the prognosis,which is worthy of clinical application.%目的 探讨胸腔闭式引流联合尿激酶治疗结核性包裹性胸腔积液的临床效果.方法 选择2006年2月至2012年3月我院结核科收治的结核性包裹性胸腔积液病例共104例,随机分为实验组和对照组各52例,实验组采用胸腔闭式引流联合尿激酶治疗,而对照组则只采用胸腔闭式引流进行治疗,比较两组患者治疗后结核性包裹性胸腔积液消失的时间、胸液中蛋白量及白细胞浓度、住院时间、胸膜厚度及疗效.结果 实验组患者治疗后总有效率(88.5％)明显较对照组总有效率(67.3％)高,差异有统计学意义(P＜0.05).实验组患者治疗后蛋白量及白细胞浓度较治疗前明显减低,差异有统计学意义(P＜0.05).而对照组患者治疗前后蛋白量及白细胞浓度差异无统计学意义(P＞0.05).实验组患者治疗后于(6.2±1.2)d胸水消失,住院时间为(10.5±5.5)d,较对照组明显短,3个月后复查胸膜厚度为(1.5±0.5)mm,较对照组小,差异有统计学意义(P＜0.05).结论 对结核性包裹性胸腔积液的患者采用胸腔闭式引流联合尿激酶治疗,可加快胸腔积液吸收,减轻胸膜粘连,减少并发症,缩短住院时间,改善预后,值得临床推广使用.