胸腔注射糖皮质激素辅助治疗结核性胸膜炎的效果  

Effect of intrapleural injection of glucocorticoid in the adjuvant treatment of tuberculous pleurisy

作　　者：黄屹 HUANG Yi(Department of Internal Medicine,Hunan Chest Hospital,Changsha 410006,China)

机构地区：[1]湖南省胸科医院内七科,长沙市410006

出　　处：《临床合理用药杂志》2023年第15期19-22,共4页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的 观察胸腔注射糖皮质激素辅助治疗结核性胸膜炎(TP)的效果。方法 选取2019年1月—2021年12月湖南省胸科医院收治的70例TP患者,按照随机数字表法分为对照组和观察组,各35例。对照组患者采用标准四联抗结核疗法,观察组患者在对照组基础上胸腔注射注射用地塞米松磷酸钠,2组均治疗6周。比较2组胸腔积液吸收时间、引流量,治疗前及治疗6周后胸膜厚度、炎性因子[转化生长因子-β1(TGF-β1)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]、肺功能指标[肺活量占预计值百分比(VC%pred)、用力肺活量占预计值百分比(FVC%pred)、肺总量占预计值百分比(TLC%pred)],并发症及胸膜粘连发生情况。结果 观察组胸腔积液吸收时间短于对照组,引流量少于对照组,治疗6周后胸膜厚度小于对照组(P<0.05或P<0.01)。治疗6周后,2组血清TGF-β1、IL-6、TNF-α水平低于治疗前,VC%pred、FVC%pred、TLC%pred高于治疗前,且观察组降低/升高幅度大于对照组(P<0.05或P<0.01)。2组并发症总发生率比较无统计学差异(P>0.05)。观察组胸膜粘连发生率为5.71%,低于对照组的22.86%(χ^(2)=4.200,P=0.040)。结论 胸腔注射糖皮质激素辅助治疗TP能有效减轻机体炎症,减少积液渗出,加快胸腔积液吸收,降低胸膜肥厚和粘连发生风险,改善肺功能,且不会增加并发症,安全性较高。Objective To investigate the effect of intrapleural injection of glucocorticoid in the adjuvant treatment of tuberculous pleurisy(TP).Methods A total of 70 cases of TP patients admitted to Hunan Chest Hospital from January 2019 to December 2021 were selected,and they were divided into the control group and the observation group according to the random number table method,with 35 cases in each group.The control group was given standard quadruple anti-nodal therapy,and the observation group was given intrapleural injection of dexamethasone on the basis of the control group.Both groups were treated for 6 weeks.Absorption time of pleural effusion,drainage volume and pleural thickness,inflammatory factors(TGF-β1,IL-6,TNF-α),pulmonary function indexes(VC%pred,FVC%pred,TLC%pred)before and after 6 weeks of treatment,incidence of complications and pleural adhesion of the two groups were compared.Results The observation group of absorption time of pleural effusion was shorter than that in the control group,drainage volume was less than that in the control group,and the pleural thickness after 6 weeks of treatment was smaller than that in the control group(P<0.05 or P<0.01).After 6 weeks of treatment,serum levels of TGF-β1,IL-6,TNF-αin the two groups were lower than those before treatment,VC%pred,FVC%pred,TLC%pred were higher than those before treatment,and the decrease/increase of the above indexes in the observation group were greater than those in the control group(P<0.05 or P<0.01).There was no statistical difference in the incidence of complications between the two groups(P>0.05).The incidence of pleural adhesion in the observation group was 5.71%,significantly lower than 22.86%of the control group(χ^(2)=4.200,P=0.040).Conclusion Intrapleural injection of glucocorticoid adjuvant therapy for TP can effectively relieve body inflammation,reduce effusion exudation,and accelerate pleural fluid absorption,and reduce the risk of pleural hypertrophy and adhesion,improve pulmonary function,and without increasing complicati

关 键 词：结核性胸膜炎 胸腔注射 糖皮质激素 肺功能 

分 类 号：R521.7[医药卫生—内科学]