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目的探讨糜蛋白酶在治疗骨关节结核合并脓肿方面的效果。方法选取2011年1月—2015年6月来湖南省胸科(结核病)医院就诊的骨关节结核合并脓肿的患者100例,随机分为观察组和对照组,每组50例。观察组进行常规“异烟肼、利福平、吡嗪酰胺、乙胺丁醇”联合抗结核治疗基础上,脓腔内注射糜蛋白酶8 000 U(用20 ml生理盐水稀释),对照组在常规治疗的基础上,脓腔内注射20 ml生理盐水,1次/2d。观察组和对照组均治疗4周,治疗前后查患者疼痛视觉模拟评分、患者血沉、C-反应蛋白,记录脓肿部位B超、CT表现,并抽取少量脓液观察颜色、密度,并记录每日引流液颜色及引流量。采用SPSS 17.0软件对数据进行统计学分析,计量资料采用t检验,计数资料采用χ2检验,P<0.05表示差异有统计学意义。结果经过4周的治疗后,观察组患者较治疗前疼痛评分由平均9.0降低到2.6,血沉由平均24.0 mm/h降低到15.7 mm/h,C-反应蛋白由平均13.1 g/L降低到8.3 g/L,脓腔引流量由平均14.0 ml增加至24.2 ml,B超、CT表现以及脓液状态方面改善明显,差异均有统计学意义(P<0.05),并且较对照组改善明显(P<0.05)。结论常规抗结核治疗基础上对骨关节结核脓腔注射糜蛋白酶治疗效果优于单纯抗结核治疗。
Objective To investigate the effect of chymotrypsin in the treatment of osteoarticular tuberculosis complicated with abscess. Methods A total of 100 patients with tuberculosis and tuberculosis complicated with abscess who visited the Thoracic Department (Tuberculosis) Hospital of Hunan Province from January 2011 to June 2015 were randomly divided into observation group and control group with 50 cases in each group. The observation group was treated with conventional “isoniazid, rifampicin, pyrazinamide and ethambutol” combination anti-TB therapy, and the chymase 8 000 U (diluted with 20 ml normal saline) On the basis of routine treatment, the abscess was injected with 20 ml of saline once a day for 2 days. The observation group and the control group were treated for 4 weeks. Before and after treatment, pain visual analog scale, erythrocyte sedimentation rate, C-reactive protein, B ultrasound and CT findings of abscess were recorded. A small amount of pus was drawn to observe the color and density. Drainage fluid color and drainage. SPSS 17.0 software was used for statistical analysis of the data, measurement data using t test, count data using χ2 test, P <0.05 said the difference was statistically significant. Results After 4 weeks of treatment, the pain score of patients in the observation group decreased from an average of 9.0 to 2.6 after treatment, the erythrocyte sedimentation rate decreased from 24.0 mm / h to 15.7 mm / h and the average C-reactive protein decreased from 13.1 g / L to 8.3 g / L, abscess drainage increased from an average of 14.0 ml to 24.2 ml, B ultrasound, CT findings and pus status improved significantly, the difference was statistically significant (P <0.05), and significantly improved compared with the control group <0.05). Conclusion Conventional antituberculous therapy is superior to antituberculous therapy alone in the injection of chymotrypsin in the abscess of the bone and joint tuberculosis.