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目的探讨经中心静脉导管治疗大量结核性胸腔积液的方法、机制及疗效。方法中心静脉导管在B超定位后常规胸穿,间断性放液并腔内注入药物,常规抗结核治疗,随诊1年,观察有无复发及胸膜肥厚情况。结果①对照组:双侧常规胸穿抽液加抗结核治疗,10例病情好转,胸水消失时间(28.7±6.7),一年后胸膜肥厚;12例治疗1周效差而改用中心静脉导管治疗,胸水消失时间(6.5±2.8)d,1年无明显胸膜增厚;②治疗组:22例直接采用中心静脉导管加抗结核治疗,胸水消失时间为(5.8±2.8)d,明显短于单纯胸穿组(P<0.05),1年后无明显胸膜增厚。结论经中心静脉导管并腔内药物注射治疗大量结核性胸腔积液具有操作简便,安全可靠,患者易耐受,不影响日常活动和休息同时减少了并发症。
Objective To investigate the method, mechanism and efficacy of transcatheter arterial catheterization in treating massive tuberculous pleural effusion. Methods Central venous catheter was routinely performed with thoracentesis through B-mode ultrasonography. The drug was injected intermittently and intracavity. Conventional antituberculous therapy was followed up for 1 year to observe the recurrence and pleural hypertrophy. Results ① In control group, bilateral thoracentesis and antituberculosis were performed. Ten cases improved, pleural effusion disappeared (28.7 ± 6.7) and pleural thickening was observed one year later. Twelve cases were treated with central venous catheter Treatment, pleural effusion disappeared time (6.5 ± 2.8) d, 1 year without significant pleural thickening; ② treatment group: 22 cases of central venous catheter plus anti-TB treatment, pleural effusion disappeared time (5.8 ± 2.8) d, Simple thoracentesis group (P <0.05), no significant pleural thickening after 1 year. Conclusion The central venous catheter intracavitary drug injection for the treatment of a large number of tuberculous pleural effusion has the advantages of simple, safe, reliable, patient tolerance, does not affect the daily activities and rest and reduce complications.