不同频次胸腔穿刺抽液及置管引流对肝硬化失代偿期合并顽固性胸水患者的影响  

The effect on refractory hydrothorax patients undergoing thoracocentesis and intrapleural catheter placement with different frequency

作　　者：李海军[1] 郭志梅[2] 杨新英[1] 康富标[1] 孙殿兴[1] Li Haijun Guo Zhimei Yang Xinying Kang Fubiao Sun Dianxing(Liver Disease Diagnosis and Treatment Center, Bethune International Peace Hospital of PLA, Shijiazhuang 050082, Chin Department of Neonatology, Bethune International Peace Hospital of PLA , Shijiazhuang 050082, China)

机构地区：[1]解放军白求恩国际和平医院肝病传染科,石家庄050082 [2]解放军白求恩国际和平医院新生儿科,石家庄050082

出　　处：《国际流行病学传染病学杂志》2017年第2期85-89,共5页International Journal of Epidemiology and Infectious Disease

摘　　要：目的 评价不同频次胸腔穿刺抽液及胸腔置管引流治疗乙型肝炎肝硬化失代偿期合并顽固性肝性胸水（RHH）患者的安全性及疗效.方法 对2010年1月1日至2015年5月30日在白求恩国际和平医院住院的168例乙型肝炎肝硬化失代偿期合并RHH患者,随机分成4组：胸腔穿刺抽液1组（T1组,1周抽液2次）、胸腔穿刺抽液2组（T2组,1周抽液3次）、胸腔置管引流1组（ICP1组,1周抽液2次）和胸腔置管引流2组（ICP2组,隔日抽液1次）.每组患者42例,记录患者实验室检查结果,观察胸水消退情况、并发症等资料.结果 4组患者尿素氮、白蛋白、血钾、血钠和Child-Pugh评分比较差异均有统计学意义（F=8.239、6.194、7.832、5.478和9.486,P＜0.05或＜0.01）.4组患者合并感染、穿刺部位渗液、穿刺部位缝合、输白蛋白比例总体比较差异均有统计学意义（χ^2=7.546、67.862、47.328和9.136,P＜0.05或＜0.01）.T1组感染率为4.76％,低于ICP1和ICP2组（=4.086和5.126,P均＜0.05）.T1和T2组穿刺部位渗液发生率分别为4.76％和7.14％,低于ICP1和ICP2组,差异均有统计学意义（χ^2=52.603、47.069和49.208、43.750;P均＜0.01）.T1组与T2组的穿刺部位缝合率均为0,低于ICP1和ICP2组患者（χ^2=37.655和42.000,P均＜0.01）.T1组的输白蛋白率为59.52％,低于T2组和ICP2组患者（χ^2=4.613和7.244,P均＜0.05）;ICP1组的输白蛋白率为66.67％,低于ICP2组（χ^2=4.200,P＜0.05）.各组采用胸腔穿刺抽液或胸腔置管引流治疗RHH治愈加显效率均在70％以上,各组间疗效比较差异均无统计学意义（P均＞0.05）.结论 胸腔穿刺抽液较胸腔置管引流患者并发感染、穿刺部位渗液、穿刺部位愈合困难明显降低.胸腔穿刺抽液每周2次治疗RHH疗效确切、安全性高,胸腔置管引流治疗RHH对患者的利弊仍需进一步评价.Objective To investigate the safety and efficacy of different frequency of thoracocentesis and intrapleural catheter placement （ICP） for treatment of patients with decompensated hepatitis B cirrhosis with refractory hepatic hydrothorax （RHH）.Methods A total of 168 RHH patients in Bethune International Peace Hospital were enrolled in the study from January 1st,2010 to May 30th,2015 and were randomly divided into the following four groups：T1 group （n=42） treated with thoracocentesis twice a week,T2 group （n=42） treated with thoracocentesis three times a week,ICP1 group （n=42） drained pleural effusion twice a week,and ICP2 group drained pleural effusion on alternate days.The results of clinical laboratory examination and tests were documented,while the fadeaway of pleural effusion and complications were observed.Results The levels of blood urea nitrogen （BUN）,albumin,serum potassium,plasma sodium and Child-Pugh scores in four groups were all significantly different （F=8.239,6.194,7.832,5.478 and 9.486,P〈0.05 or 〈0.01）.The proportions of infection,effusion of puncture points,puncture point suture and supplement albumin in four groups were all significantly different （χ^2=7.546,67.862,47.328 and 9.136,P〈0.05 or 〈0.01）.The infection rate in T1 group （4.76%） was significantly lower than ICP1 and ICP2 groups （χ^2=4.086and 5.126,P both 〈0.05）.The incidence rates of puncture point effusion in T1 and T2 groups were 4.76% and 7.14%,which were lower than those of ICP1 and ICP2 groups with significant differences （χ^2=52.603,47.069 and 49.208,43.750,P all〈0.01）.The proportions of puncture point suture in T1 and T2 groups were 0,which were all lower than ICP1 and ICP2 groups with significant differences （χ^2=37.655,42.000,P〈0.01）.The proportion of supplement albumin in T1 group （59.52%） was significantly lower than T2 and ICP2 groups （χ^2=4.613 and 7.244,Pboth 〈0.05）,and the proportion in ICP1 group （66.67%） was significantly lower than ICP2 grou

关 键 词：胸水 胸腔穿刺 胸腔置管 疗效 

分 类 号：R575.2[医药卫生—消化系统]