胸腔置管联合透明质酸钠防治结核性胸膜炎胸膜肥厚：成本效果分析

摘要/Abstract

摘要： 目的探索防治结核性胸膜炎胸膜肥厚成本低、效果好的治疗方法。方法64例中至大量游离结核性胸腔积液患者随机分为治疗组和对照组。治疗组胸腔置管完全引流积液后注入透明质酸钠，对照组常规胸穿抽液。统计治疗3个月后2组花费的成本，进行成本效果分析及敏感度分析。结果59例患者参与最后结果分析。治疗3个月后治疗组、对照组胸膜肥厚发生率是6.7%、31.0%（有效率分别是：93.3%、69.0%）（P＜0.05）；成本效果比（C/E）是35.19，47.53，敏感度分析显示C/E 35.63，49.00。结论胸腔置管联合透明质酸钠防治结核性胸膜炎胸膜肥厚是成本低、效果好的方法。

关键词: 结核, 胸膜/并发症, 结核, 胸膜/经济学, 胸膜疾病, 引流术, 透明质酸, 成本及成本分析

Abstract: ObjectiveTo explore the method of lower cost and better results.to prevent pleural thickening(PT) of tuberculous pleurisy. MethodsSixty-four patients with middle to large plerural effusions were randomly assigned to a treatment group and a control group. Patients in treatment group given with sodium hyaluronate via central venous catheter into the thoracic cavity after pleural effusion was drainaged completely，while patients in control group received routine thoracentesis. We calculated the cost after 3 months in two groups respectively and analyzed the cost-effectiveness and sensitivity. ResultsFifty-nine patients were available for final analysis. The incidence rate of PT at 3rd month were 6.7% in treatment group and 31.0% in control group（the effective rate: 93.3% vs. 69.0%,respectively）with statistically significant difference（P＜0.05）；The cost/effective rate were 35.2 in the treatment group and 47.5 in the control group. Sensitivity analysis showed 35.6 in the treatment group and 49.00 in the control group. ConclusionsIntrathoracic cannula combining with administration of sodium hyaluronate is a method of lower cost and better Results to prevent pleural thickening of tuberculous pleurisy.

Key words: Tuberculosis,pleural/complications, Tuberculosis,pleural/economics, Pleural diseases, Drainage, Hyaluronic acid, Costs and cost analysis

周爱莲,孙俊生,何建猷. 胸腔置管联合透明质酸钠防治结核性胸膜炎胸膜肥厚：成本效果分析[J]. 中国防痨杂志, 2009, 31(8): 487-490.

Zhou Ailian¹, Sun Junsheng², He Jianyou³. Intrathoracic cannula combining with sodium hyaluronate to prevent pleural thickening of tuberculous pleurisy: cost/effective analysis[J]. Chinese Journal of Antituberculosis, 2009, 31(8): 487-490.

参考文献

[1] 蔡柏蔷，李龙芸.协和呼吸病学[M].北京：中国协和医科大学出版社，2005，1329-1331.
[2] 陈莉延,李文,宋泽庆，梁标. 改良经皮穿刺胸腔置管引流术并腔内化疗治疗血性恶性胸腔积液[J]. 现代肿瘤医学,2005,13(2)：235-236.
[3] 陈文彬,潘祥林.诊断学(第6版)[M].北京:人民卫生出版社，2004：585-586.
[4] De Pablo A, Villena V, Echave-Sustaeta J, Encuentra AL. Are pleural fluid parameters related to the development of residual pleural thickening in tuberculosis? [J]. Chest,1997,112（5）: 1293-1297.
[5] 张昕，郭振永. 3 种抗结核短程化疗方案成本-效果分析[J].中国药房，2001，12（8）：473-474.
[6] Lai Y-F, Chao T-Y, Wang Y-H, Lin A-S. Pigtail drainage in the treatment of tuberculous pleural effusions:a randomised study[J]. Thorax, 2003,58(2):149-151.
[7] Kwak SM, Park CS, Cho JH, Ryu JS, Kim SK, Chang J, Kim SK.The effects of urokinase instillation therapy via percutaneous transthoracic catheter in loculated tuberculous pleural effusion: a randomized prospective[J]. Yonsei Med J, 2004,45(5):822-828.
[8] 高卫红,袁东运,徐立江.深静脉导管胸腔闭式引流术治疗结核性胸膜炎的临床观察[J].中国防痨杂志，2005，27（2）：132-133.
[9] Reijnen MM, Bleichrodt RP, van Goor H. Pathophysiology of intra-abdominal adhesion and abscess formation, and the effect of hyaluronan[J]. Br J Surg, 2003,90(5):533-541.
[10] Chen WY, Abatangelo G. Functions of hyaluronan in wound repair[J]. Wound Repair Regen, 1999,7(2):79-89.
[11] Zhou A, Guo L, Tang L. Effect of an intrathoracic injection of sodium hyaluronic acid on the prevention of pleural thickening in excess fluid of tuberculous thoracic cavity[J]. Clin Exp Pharmacol Physiol,2003,30（3）：203-205.

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