ARROW中心静脉三通导管微创置入胸膜腔引流联合胸膜腔注入凝血酶治疗恶性胸腔积液  

Insertion of a central venous catheter for instillation of thrombin through a chest drain T tube for treatment of patients with malignant pleural effusion

作　　者：孙军[1,2] 高忠和[1] 刘华莎[1] 周曦[1] 张锋[1] 杨玲[1] 方陈[1] 陈寒[1] 韩忠朝[2] 

机构地区：[1]安徽省蚌埠市第三人民医院呼吸内科,233000 [2]北京协和医学院国家干细胞中心,300020

出　　处：《蚌埠医学院学报》2010年第10期1009-1011,共3页Journal of Bengbu Medical College

摘　　要：目的:探讨胸膜腔注入凝血酶联合ARROW中心静脉三通导管微创置入胸腔引流治疗恶性胸腔积液的临床应用价值。方法:对32例恶性胸腔积液(A组)患者在B超定位下,进行胸腔微创置ARROW中心静脉三通导管引流,并每次注入凝血酶1 000 u。分别与36例常规胸腔穿刺抽液(B组)和29例传统胸腔闭式引流术(C组)对比。结果:A组症状缓解人数(13/3)、总有效率(90.6%)、胸膜粘连发生率(62.5%)、胸腔积液治疗后减少百分比(76±6.3)%、引流的液体量(4 900±150)ml、引流天数(5±1.2)天、住院时间(17±2.9)天,均优于B组(P<0.01)。A组并发症少,引流的液体量少,引流和住院时间短,优于C组(P<0.05～P<0.01)。结论:在B超定位下微创置入ARROW中心静脉导管,通过三通管注入凝血酶至胸膜腔,是一种简便、有效、安全、可靠且易被患者接受的引流治疗方法。Objective：To demonstrate the efficacy,safety and appropriate mode of inserting a pleural catheter for thrombin in treatment of malignant pleural effusion.Methods：With the guidance of ultrasound,32 patients with malignant pleural effusion were inserted implantable pleural catheter for instillation of thrombin,and the result was compared with that of 36 cases treated by conventional chest puncture drainage and 29 cases by traditional closed thoracic drainage.Results：In the ARROW central venous catheter group,the number of symptom relief（13/3）,total effective rate（90.6%）,pleural adhesion rate（62.5%）,percentage of pleural effusion decrease after treatment（76±6.3）%,drainage volume of fluid（4 900±150）ml,treatment time（5±1.2）days and hospital stay（17±2.9）days all surpassed those of the conventional chest puncture drainage group（P0.01）.The central venous catheter group had less complication,less liquid drainage and shorter hospital stay than the traditional closed thoracic drainage group（P0.05～P0.01）.Conclusions：The insertion of a central venous catheter for instillation of thrombin through a chest drain T tube is simple,effective and safe for treatment of patients with malignant pleural effusion,which accepted welcome by majority of the patients.

关 键 词：胸腔积液 引流 微创 中心静脉三通导管 凝血酶 

分 类 号：R561.3[医药卫生—呼吸系统]