尿激酶联合臭氧序贯冲洗辅助治疗结核性包裹性胸腔积液的临床效果

doi:10.3969/j.issn.1000-6621.2018.10.013

摘要/Abstract

摘要：

目的探讨尿激酶联合臭氧序贯冲洗方案辅助治疗结核性包裹性胸腔积液的疗效及安全性。方法选取首都医科大学附属北京地坛医院2016年1月至2017年12月收治的100例结核性包裹性胸腔积液患者作为研究对象,并按随机数字表法分为对照组(50例)和观察组(50例)。在置管引流基础上,对照组采用单纯尿激酶冲洗方案,观察组采用臭氧联合尿激酶序贯冲洗方案治疗;比较两组患者近期疗效、置管引流时间、胸腔积液消失时间、住院时间、药物不良反应发生情况,以及胸膜厚度、胸腔积液蛋白质、白细胞(WBC)计数水平。结果观察组治疗总有效率为92.0%(46/50),明显高于对照组的74.0%(37/50),差异有统计学意义(χ ²=9.78,P=0.01)。观察组平均置管引流时间为(8.42±1.04)d、平均胸腔积液消失时间为(8.15±1.86)d、平均住院时间为(11.82±2.39)d,均明显短于对照组上述指标[分别为(32.35±4.50)d、(14.09±2.59)d、(16.31±3.64)d],差异均有统计学意义(t值分别为3.14、3.90、4.11,P值均<0.05)。观察组治疗后胸膜厚度为(1.78±0.35)mm,胸腔积液蛋白质为(37.84±3.72)g/L,WBC计数为(1.38±0.27)×10 ³/L,均明显低于对照组[分别为(2.31±0.52)mm、(49.42±5.98)g/L、(2.03±0.42)×10 ³/L] (t值分别为2.89、3.12、3.50,P值均<0.05)。观察组药物不良反应发生率为10.0%(5/50),对照组为6.0%(3/50),两组比较,差异无统计学意义(χ ²=1.33,P=0.490)。结论尿激酶联合臭氧序贯冲洗方案辅助治疗结核性包裹性胸腔积液安全且疗效优于单纯尿激酶方案。

关键词: 结核, 胸腔积液, 尿激酶型纤溶酶原激活剂, 臭氧, 引流术

Abstract:

Objective To investigate the efficacy and safety of urokinase washout uses alone and ozone + urokinase sequential drug washout program in the treatment of patients with tuberculous encapsulated pleural effusion. Methods One hundred patients with tuberculous encapsulated pleural effusion were chosen in the period from January 2016 to December 2017 in Beijing Ditan Hospital affiliated to Capital Medical University and randomly divided into two groups including control group (n=50) and observation group (n=50). Patients in the control group were given urokinase washout program and those in the observation group were given ozone + urokinase sequential drug washout program assisted with thoracic drainage. The short-term efficacy, drainage time, disappearance time of pleural effusion, hospitalization time, pleural thickness and the levels of pleural effusion protein and WBC count before and after treatment and the frequency of adverse reactions of both groups were compared. Results The overall effective rate of the observation group after treatment was significant higher than that of the control group (92.0% (46/50) vs 74.0% (37/50); χ ²=9.78, P=0.01). The drainage time, disappearance time of pleural effusion and hospitalization time of the observation group after treatment were significant shorter than those of the control group ((8.42±1.04)d vs (32.35±4.50)d, (8.15±1.86)d vs (14.09±2.59)d, and (11.82±2.39)d vs (16.31±3.64)d, respectively; t=3.14, 3.90, and 4.11, respectively; all Ps<0.05). The pleural thickness and the levels of pleural effusion protein and WBC count after treatment of observation group were significant less than those of the control group ((1.78±0.35) mm vs (2.31±0.52) mm, (37.84±3.72) g/L vs (49.42±5.98) g/L, and (1.38±0.27)×10 ³/L vs (2.03±0.42)×10 ³/L, respectively; t=2.89, 3.12, and 3.50, respectively; all Ps<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (10.0% (5/50) vs 6.0% (3/50); χ ²=1.33, P=0.490). Conclusion Compared with urokinase washout uses alone, ozone + urokinase sequential drug washout program in the treatment of patients with tuberculous encapsulated pleural effusion possess the better clinical efficacy.

Key words: Tuberculosis, Pleural effusion, Urokinase-type plasminogen activator, Ozone, Drainage

陈玲,卢利红,孙君红. 尿激酶联合臭氧序贯冲洗辅助治疗结核性包裹性胸腔积液的临床效果[J]. 中国防痨杂志, 2018, 40(10): 1095-1098. doi: 10.3969/j.issn.1000-6621.2018.10.013

Ling CHEN,Li-hong LU,Jun-hong SUN. Clinical efficacy of urokinase combined with ozone sequential irrigation in the treatment of tuberculous encapsulated pleural effusion[J]. Chinese Journal of Antituberculosis, 2018, 40(10): 1095-1098. doi: 10.3969/j.issn.1000-6621.2018.10.013

图/表 1

表1

两组治疗前后胸膜厚度、胸腔积液蛋白质及WBC计数水平

组别	例数	胸膜厚度 (mm, $x ˉ$ ±s)		胸腔积液蛋白质 (g/L, $x ˉ$ ±s)		胸腔积液WBC计数 (×10³/L, $x ˉ$ ±s)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	50	3.76±1.17	2.31±0.52	54.75±8.07	49.42±5.98	2.92±0.68	2.03±0.42
观察组	50	3.83±1.20	1.78±0.35	54.59±8.03	37.84±3.72	2.88±0.65	1.38±0.27

表1

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