胸腔闭式引流联合尿激酶灌注治疗结核性胸膜炎的临床观察

目的观察胸腔闭式引流联合尿激酶灌注对结核性渗出性胸膜炎的治疗效果。方法75例初治结核性胸膜炎患者．在规范抗结核药物治疗基础上，随机分为常规治疗组（对照组）及闭式引流联合尿激酶灌注组（治疗组），对照组反复胸腔穿刺抽液，每周2-3次；治疗组行胸穿留置中心静脉导管引流胸水，并每日尿激酶胸腔冲洗。比较两组病人胸水消失时间、住院治疗时间、胸膜粘连（包裹性胸腔积液）出现机会及治疗3个月后胸膜厚度。结果治疗组胸水消失时间（6．5±213）d，住院时间（11．8±5．2）d，没有病例出现胸膜粘连，3个月后胸膜厚度（1．8±0．7）mm；对照组胸水消失时间（11．4±5．1）d，住院时间（15．2±6．9）d，8例出现胸膜粘连，3个月后胸膜厚度（4．2±1．2）mm。结论胸腔闭式引流联合尿激酶冲洗治疗初治结核性胸膜炎患者可以加快胸水消失，缩短住院治疗时间，预防胸膜增厚粘连，改善患者预后。

Clinical observation of thoracic close drainage combined with perfusion of urokinase in the treatment of tuberculous pleuritis

Objective： To observate the effect of thoracic close drainage combined with perfusion of urokinase on the treatment of tuberculous pleuritis. Methods： 75 initial treatment cases of tuberculous pleurisy were randomly divided into two group, the control group was received the simple thoracic cavity puncture pumping fluids （2-3 times a week）; the treatment group was treated with inserting central venous catheter to constant drainage, and perfused with urokinase into chest everyday. The hydrothorax disappearance time, the hospitalization time, the rate of pleural adhesions （wrapped pleural effusion） and the pleural thickness after three months in above groups were compared. Results： In the treatment group, the hydrothorax disappearance average time was （6.5±2.3）days,the average hospitallization time was （11.8±5.2）days, the pleural thickness after three months was（1.8±0.7）mm;those of the control group were（11.4±5.1）days, （15.2±6.9） days and（4.2±1.2） ram. No pleural adhesions occurred in treatment group, but in control group, pleural adhesions occurred in 8 case. Conclusion： The application of thoracic close drainage combined with perfusion of urokinase in the treatment of tuberculous pleuritis can speed up the disappearance of pleural effusion,shorten the time for hospital treatment, prevent from pleural thickening and adhesion ,and so improve the prognosis.