腔内注射对恶性胸腔积液治疗效果的研究进展  

Research Progress of Intracavitary Injection in the Treatment of Malignant Pleural Effusion

作　　者：崔淼 刘双 CUI Miao;LIU Shuang(Department of Pulmonary and Critical Care Medicine,Peking University International Hospital,Beijing 102206,China)

机构地区：[1]北京大学国际医院呼吸与危重症医学科,北京102206

出　　处：《中国继续医学教育》2021年第11期195-198,共4页China Continuing Medical Education

摘　　要：恶性胸腔积液是晚期恶性肿瘤的严重并发症之一,可引起胸痛、呼吸困难、乏力等症状,降低患者的生活质量。临床上对于恶性胸腔积液的治疗多以胸腔置管引流为主,以缓解症状为主要目的,不仅不能解决胸腔积液生成的问题,还会因反复穿刺增加组织纤维化、胸腔内感染的风险。随着对胸腔积液产生原理的认识,在置管引流的基础上行胸腔内注射治疗正逐步成为抑制恶性胸腔积液生成的主要措施。国内外研究证实,热灌注治疗、铂类药物、重组人血管内皮抑制素、贝伐珠单抗等药物都可以抑制胸腔积液的产生。但是灌注药物的方式、剂量、联合用药方案种类繁多,多由临床医师根据临床实践确定,没有统一标准,各种方案的效果也少有对比。文章对目前常用的胸腔内灌注治疗(intrapleural perfusion therapy,IPT)做一综述,旨在为临床治疗提供多种思路,促进这一疗法的规范和发展。Malignant pleural effusion is one of the most important complications of advanced malignant tumor,the main clinical symptoms are chest pain,dyspnea,fatigue,which can reduce the quality of life of patients.Formerly,thoracentesis was the ordinary treatment for malignant pleural effusion.It could decrease distress but could not solve the formation of pleural effusion;on the other hand,repeated thoracentesis also increase tissue fibrosis and intrathoracic infection.With the understanding of the principle of pleural effusion,perfusion therapy is gradually becoming the most effective way to control.Studies have confirmed that hyperthermic perfusion therapy,recombinant human endostatin,bevacizumab and platinum drugs can inhibit the formation of malignant effusion.However,there is no unified standard about ways,types,dosages and combined drug regimens of perfusion drugs.Doctors determined by their clinical practice,and the various of effect are less compared.In this paper,the current commonly used intrapleural perfusion therapy(IPT)is reviewed in order to provide a variety of ideas and means for clinical treatment,and promote the standardization and development of this therapy.

关 键 词：恶性胸腔积液 胸腔内灌注 热灌注疗法 铂类药物 重组人血管内皮抑制素 贝伐珠单抗 

分 类 号：R561[医药卫生—呼吸系统]