123例微创置管治疗胸腔积液疗效分析  

Effect of 123 cases of minimally invasive catheter in the treatment of pleural effusion

作　　者：周燕[1] 胡蝶[1] 杨厚宇[1] 

机构地区：[1]四川省都江堰市人民医院呼吸内科,四川都江堰611800

出　　处：《吉林医学》2016年第6期1335-1337,共3页Jilin Medical Journal

摘　　要：目的：探讨中心静脉导管穿刺置管引流术（微创置管）治疗胸腔积液的可靠性和临床意义。方法：选取采用微创置管治疗的123例胸腔积液患者作回顾性分析。平均年龄57岁。对患者进行B超定位,定位最多积液处,于肋间穿刺,回抽见积液后停止进针,经穿刺针植入导引导丝于胸膜腔内,退出穿刺针,扩张器经导引导丝扩皮后,经导引导丝置入中心静脉导管于胸膜腔内5～10 cm。此外,均根据原发疾病给予抗结核、抗感染、肿瘤放化疗等对因治疗、对症治疗。结果：123例患者,结核最多,占49.59%,肿瘤居次,占16.26%,肺部感染也较多,占15.45%,此外,心力衰竭8例（6.50%）,肝硬化6例（4.88%）,不明原因9例（7.32%）。微创置管配合病因治疗,显效74.80%,有效17.07%,无效8.13%,总有效率达91.87%。有效率较高的为结核（100%）、肺部感染（100%）;肿瘤仅为75%,较低的还有心力衰竭、肝硬化、不明原因。其中,61例结核的有效率与20例肿瘤相比,差异有统计学意义（χ^2=16.25,P=0.000）。并发症总发生率20.33%,包括再次置管（6.50%）,引流管脱出（4.07%）,胸膜反应（4.07%）,皮肤感染（3.25%）,局部血肿（1.63%）,气胸（0.81%）。结论：胸腔积液以结核为多见,微创置管治疗胸腔积液疗效确切,并发症较少且症状较轻;尤其是对结核、肺部感染等良性胸腔积液。Objective To observe the reliability and clinical significance of thoracic cavity drainage with center venous catheter（ CVC） in the treatment of pleural effusion（ PE）. Method The clinical data of 123 cases with PE treated with CVC were analyzed retrospectively. Average age of these cases were 57. The site of effusing at most was located with B ultrasound,and intercostal puncture was performed at this site and stopped after seeing the effusion. Then a guide wire was implanted via the needle into the pleural cavity（ PC）,and the needle was pulled out. Then a dilator was implanted via the guide wire in order to expanse the skin. Eventually,a CVC was placed into the PC 5 ～ 10 cm. In addition,etiological treatment and symptomatic treatment were carried out in order to cure tuberculosis,infection and tumor and so on. Results Among the 123 cases,there were tuberculosis（ 49. 59%）,tumor（ 16. 26%）,pulmonary infection（ 15. 45%）,heart failure（ 6. 50%）,hepatocirrhosis（ 4. 88%）,unexplained disease（ 7. 32%） respectively. The treatment showed that there were 74. 80% significant effectively,17. 07% effectively and 8. 13% invalid. Tuberculosis and pulmonary infection had higher effective rate（ both 100%） than tumor（ only 75%）,heart failure,hepatocirrhosis and unexplained disease,and there was significant between tuberculosis and tumor（ χ^2= 16. 25,P = 0. 000）. The total incidence of complications was 20. 33%,including tube again 6. 50%,tube prolapsed 4. 07%,pleural reaction 4. 07%,skin infection3. 25%,local hematoma 1. 63%,pneumothorax 0. 81%. Conclusion The tuberculosis is the most common cause of PE. CVC is convenient,safe and effective to closed drainage of PE,especially to the benign PE rather than to the malignant PE.

关 键 词：中心静脉导管 胸腔积液 闭式引流 

分 类 号：R655[医药卫生—外科学]