中心静脉导管闭式引流联合免疫抑制剂治疗肺癌恶性胸腔积液的效果和安全性  

Clinical effect and safety of central venous catheter closure drainage combined with immunosuppressant therapy on malignant pleural effusion in patients with lung cancer

作　　者：张杰 林献阳 刘起 Zhang Jie;Lin Xianyang;Liu Qi(Department of Respiratory,the First People’s Hospital of Zhumadian,Zhumadian 463000,China;Department of Urology Surgery,Zhumadian Central Hospital,Zhumadian 463000,China)

机构地区：[1]驻马店市第一人民医院呼吸科,驻马店463000 [2]驻马店市中心医院泌尿外科,驻马店463000

出　　处：《中国实用医刊》2023年第11期8-12,共5页Chinese Journal of Practical Medicine

摘　　要：目的分析中心静脉导管闭式引流联合免疫抑制剂方案对肺癌恶性胸腔积液的临床治疗效果及安全性。方法抽取2020年11月至2022年9月驻马店市第一人民医院收治的67例肺癌恶性胸腔积液患者为研究对象,经分段随机化分组法分为对照组(33例)和研究组(34例)。对照组行超声引导下胸腔穿刺引流+顺铂治疗,研究组行中心静脉导管闭式引流+顺铂+贝伐珠单抗治疗。比较两组患者胸腔积液治疗有效率,治疗期间肺复张时间、住院时间、残留胸水量,血清肿瘤标志物[糖类抗原153(CA153)、癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA21-1)]、胸腔积液炎症因子[白细胞介素-2(IL-2)、白细胞介素-6(IL-6)、γ干扰素(IFN-γ)]水平,治疗并发症发生率,药物不良反应发生率。结果治疗后,研究组完全缓解率、部分缓解率(41.18%,14/34;47.06%,16/34)均高于对照组(24.24%,8/33;42.42%,14/33),P均<0.05。治疗后,研究组肺复张时间、住院时间、残留胸水量均少于对照组(P均<0.05)。治疗后,研究组CA153、CYFRA21-1、CEA、IL-6水平低于对照组,IL-2、IFN-γ水平高于对照组(P<0.05)。研究组治疗并发症发生率(5.88%,2/34)低于对照组(24.24%,8/33),P<0.05。两组消化系统、骨髓抑制、出血反应发生率比较差异未见统计学意义(P>0.05)。结论中心静脉导管闭式引流+免疫抑制剂治疗肺癌恶性胸腔积液,可在安全基础上短时间内有效引流患者的胸腔积液,促进肺复张,纠正机体炎症反应程度,辅助抑制肺癌进展,降低胸腔积液诱因影响性,且无明显不良反应、安全事件风险,可满足患者临床治疗安全性、耐受需求。Objective To analyze the clinical effect and safety of central venous catheter closure drainage combined with immunosuppressant therapy on malignant pleural effusion in patients with lung cancer.Methods Sixty-seven lung cancer patients with malignant pleural effusion admitted to the First People’s Hospital of Zhumadian from November 2020 to September 2022 were selected as the study subjects,and they were divided into control group(33 cases)and study group(34 cases)by segmented randomization grouping method.The control group underwent ultrasound-guided thoracentesis drainage combined with cisplatin therapy,and the study group underwent central venous catheter closure drainage combined with cisplatin and bevacizumab therapy.The effectiveness of treatment for pleural effusion,the duration of lung recruitment,hospital stay,residual pleural volume during treatment,serum tumor markers,including carbohydrate antigen 153(CA153),carcinoembryonic antigen(CEA)and cytokeratin-19-fragment(CYFRA21-1),levels of inflammatory factors in pleural effusion,including interleukin-2(IL-2),interleukin-6(IL-6)and interferon-γ(IFN-γ),the incidence of complications and adverse drug reactions were compared between the two groups.Results After treatment,the complete and partial remission rates in the study group(41.18%,14/34;47.06%,16/34)were higher than those in the control group(24.24%,8/33;42.42%,14/33),all P<0.05.After treatment,the duration of lung recruitment,length of hospital stay in the study group were shorter than those in the control group,and residual pleural volume was lower than that in the control group(all P<0.05).After treatment,levels of CA153,CYFRA21-1,CEA,and IL-6 in the study group were lower than those in the control group,while levels of IL-2 and IFN-γwere higher than those in the control group(P<0.05).The incidence of complications in the study group(5.88%,2/34)was lower than that in the control group(24.24%,8/33),P<0.05.There was no statistically significant difference in the incidence of digestive system compl

关 键 词：肺癌 恶性胸腔积液 中心静脉导管闭式引流 免疫抑制剂 临床效果 

分 类 号：R734.2[医药卫生—肿瘤]