超声引导下抽吸冲洗加药物注入术治疗胸壁结核性脓肿的价值  

Ultrasound-guided pumping and rinsing plus drug injection in the treatment of chest wall tuberculous abscess

作　　者：徐建平[1] 蒋慧青 王大力[1] 张旭 蒋红英[1] 张林[1] Jian-ping XU;Hui-qing JIANG;Da-li WANG;Xu ZHANG;Hong-ying JIANG;Lin ZHANG(Department of Ultrasound,Integrated Chinese and Western Medicine Hospital of Zhejiang Province,Hangzhou 310003,China)

机构地区：[1]浙江省中西医结合医院超声科,杭州310003

出　　处：《中国防痨杂志》2019年第7期712-714,共3页Chinese Journal of Antituberculosis

基　　金：杭州市科技计划引导项目(20163501Y33);杭州市农业与社会发展科研主动设计项目(20190101A09);杭州市社会发展自主申报项目(20180533B68);杭州市卫生科技计划项目(2015A23).

摘　　要：目的探讨实时超声引导下抽吸冲洗加药物注入术在胸壁结核性脓肿治疗中的应用价值。方法回顾性分析2011年12月至2016年12月浙江省中西医结合医院40例经GeneXpert MTB/RIF检测诊断为胸壁结核性脓肿初治患者的资料,所有患者在采取标准H-R-Z-E口服抗结核药治疗基础上应用随机数字表法分为2组:对照组20例,口服抗结核药治疗基础上超声引导下对胸壁结核性脓肿行脓液抽吸、生理盐水冲洗,直至冲洗液清亮;观察组20例,口服抗结核药治疗的基础上采取超声引导下对胸壁结核性脓肿行脓液抽吸、生理盐水冲洗,并按抽出脓液容积的1/3~1/2量注入抗结核药与糖皮质激素(异烟肼注射液,2ml/支,100mg/支;地塞米松注射液,1ml/支,2mg/支),每周2次。比较两组患者病变的治疗总有效率。结果 2组患者治疗期以12个月为限,观察组总有效率为95.0%(19/20),高于对照组的45.0%(9/20),差异有统计学意义(χ^2=9.643,P=0.002)。结论在标准H-R-Z-E口服抗结核药物治疗的基础上,行实时超声引导下抗结核药物注入术治疗胸壁结核性脓肿,是一种临床效果可靠的微创介入治疗方法。Objective To explore the value of real-time ultrasound-guided pumping and rinsing plus drug injection in the treatment of chest wall tuberculous abscess. Methods Retrospective analysis of 40 cases of patients with tuberculous abscess of chest wall diagnosed by GeneXpert MTB/RIF from December 2011 to December 2016 in Integrated Chinese and Western Medicine Hospital of Zhejiang Province. All patients were randomly divided into two groups based on standard H-R-Z-E oral anti-tuberculosis treatment. The control group consisted of 20 patients. Based on oral anti-tuberculosis drug treatment, ultrasound-guided abscess pumping and rinsing were performed on tuberculous abscess of chest wall until the rinse water was clear. The observation group consisted of 20 patients treated with oral anti-tuberculosis drugs. Ultrasound-guided purulent pumping and saline rinsing were performed in patients with chest wall tuberculous abscess. Anti-tuberculosis drugs and glucocorticoids (Isoniazid injection,2 ml∶100 mg;Dexamethasone injection,1 ml∶2 mg) were injected twice a week according to the volume of pus extracted. The total effective rate of treatment of pathological changes was compared between the two groups. Results The treatment time of the two groups was limited to 12 months. The total effective rate of observation group was 95.0%(19/20) higher than 45.0%(9/20) of control group,the difference was statistically significant (χ^2=9.643,P=0.002). Conclusion On the basis of standard H-R-Z-E oral anti-tuberculosis drugs, real-time ultrasound-guided anti-tuberculosis drug injection is a reliable minimally invasive interventional therapy for the treatment of tuberculous abscess of the chest wall.

关 键 词：超声检查 介入性 胸壁 结核 脓肿 投药 局部 疗效比较研究 

分 类 号：R52[医药卫生—内科学]