胸腔内注射用尿激酶冲洗治疗对脓胸患者中心静脉导管置管引流效果的影响研究  

Impact of Intrathoracic Irrigation Therapy with Urokinase for Injection on Drainage Effect of Central Venous Catheter in Patients with Empyema

作　　者：郭昌[1] 顾振解 杨泽西 卢瑞琦[1] 宋建民[1] 李丽杰[1] 孙燕川 徐海亮 GUO Chang;GU Zhenjie;YANG Zexi;LU Ruiqi;SONG Jianmin;LI Lijie;SUN Yanchuan;XU Hailiang(Department of Respiratory Medicine,Baoding No.1 Central Hospital,Baoding 071000,China;Out-patient Department,the No.2 Hospital of Baoding,Baoding 071000,China)

机构地区：[1]河北省保定市第一中心医院呼吸内科,071000 [2]河北省保定市第二医院门诊部,071000

出　　处：《实用心脑肺血管病杂志》2021年第3期96-100,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：保定市科技计划项目(1951ZF061)。

摘　　要：背景促进肺复张、胸腔置管引流、胸腔穿刺抽液是临床治疗脓胸的主要手段,其治疗成功率虽较高,但易引发胸膜广泛粘连甚至造成通气功能障碍,治疗效果不尽人意。尿激酶具有降解纤维蛋白、抗炎等作用,但目前关于尿激酶在脓胸治疗中的应用效果及其对炎性因子影响的报道较少。目的探讨胸腔内注射用尿激酶冲洗治疗对脓胸患者中心静脉导管置管引流效果的影响,以期为临床治疗提供参考。方法选取2004年10月—2019年10月保定市第一中心医院收治的脓胸患者102例,随机分为对照组和研究组,各51例。两组患者均采用中心静脉导管置管引流,其中对照组患者采用0.9%氯化钠溶液+5%碳酸氢钠注射液进行冲洗,研究组患者在对照组基础上于胸腔内注入注射用尿激酶进行冲洗。比较两组患者的临床疗效、胸腔积液消失时间、体温恢复正常时间、住院时间;治疗前及治疗后7 d胸膜厚度、炎性因子;治疗前及治疗后3个月SF-36评分,并观察两组患者并发症发生情况。结果研究组患者临床疗效优于对照组(P<0.05)。研究组患者胸腔积液消失时间、体温恢复正常时间、住院时间短于对照组(P<0.05)。治疗前两组患者胸膜厚度和血清降钙素原(PCT)、超敏C反应蛋白(hs-CRP)水平及白细胞计数(WBC)比较,差异无统计学意义(P>0.05);研究组患者治疗后7 d胸膜厚度小于对照组,血清PCT、hs-CRP水平及WBC低于对照组(P<0.05)。两组患者治疗后7 d胸膜厚度分别小于本组治疗前,血清PCT、hs-CRP水平及WBC分别低于本组治疗前(P<0.05)。治疗前两组患者一般健康状况、精力、情感角色功能、心理健康、躯体疼痛、躯体角色功能、社会功能、躯体健康评分比较,差异无统计学意义(P>0.05);研究组患者治疗后3个月一般健康状况、精力、情感角色功能、心理健康、躯体疼痛、躯体角色功能、社会功能、躯体健康评分Background Promoting lung recruitment,thoracic drainage and thoracentesis are main treatments of empyema.Even with a high cure rate,traditional treatment often leads to extensive pleural adhesions and ventilation dysfunction.The therapeutic effect is not satisfactory.Degradation of fibrin and anti-inflammatory effect have been proved for urokinase.But there are few reports about the effect of urokinase irrigation on empyema and the inflammatory biomarkers.Objective To explore the impact of intrathoracic irrigation therapy with urokinase for injection on drainage effect of central venous catheter in patients with empyema,in order to provide reference for clinical treatment.Methods A total of 102 empyema patients admitted to Baoding No.1 Central Hospital from October 2004 to October 2019 were enrolled,and randomly assigned to the control group or the study group(51 patients in each group).All patients were placed of a central venous catheter for thoracic drainage.Patients in control group were treated with 0.9%sodium chloride solution+5%sodium bicarbonate as irrigation therapy,and urokinase for injection was used by intrathoracic injection as combination therapy in the study group.The clinical efficacy,disappearance time of pleural effusion,time of body temperature returned to normal,length of stay,pleural thickness and inflammatory biomarkers before treatment and 7 days after treatment,quality of life scores before treatment and 3 months after treatment were compared between the two groups.Incidence of complications of the two groups were also observed.Results Clinical efficacy of study group was better than that of control group(P<0.05).Disappearance time of pleural effusion,time of body temperature returned to normal,length of stay of study group were shorter than those of control group(P<0.05).Before treatment,there was no significant difference in pleura thickness,serum levels of procalcitonin(PCT),hypersensitive C-reactive protein(hs-CRP)and peripheral white blood cell(WBC)between the two groups(P>0.05);7 day

关 键 词：积脓 胸腔 尿激酶 胸腔注射 治疗结果 炎性反应 

分 类 号：R561.6[医药卫生—呼吸系统]