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目的评价胸腔镜联合尿激酶胸腔内注射治疗急性包裹黏连性胸腔积液的疗效。方法急性包裹黏连性胸腔积液患者58例,按照处理方法不同分为治疗组(n=27)、对照组(n=31),治疗组采用胸腔镜检查、治疗后放置胸腔闭式引流管,同时给予胸腔内注入尿激酶(10万U)保留24~48 h后引流,每周2次(可根据引流液的颜色增减次数);对照组常规胸腔置管引流。比较两组患者胸腔积液的引流量、积液蛋白含量、积液消失时间、胸膜厚度、治疗效果及并发症发生率。结果治疗组胸腔积液引流量为(1141.51±411.66)m L,显著多于对照组(751.93±605.53)m L(P<0.05);治疗组胸腔积液消失时间和胸膜厚度分别为(6.18±1.88)d和(2.09±0.50)mm,低于对照组(7.54±2.28)d和(2.90±0.57)mm(P<0.05);治疗组胸腔积液蛋白含量为(26.45±12.09)g,显著低于对照组(34.33±10.99)g(P<0.05)。治疗组有效率为96.3%(95%CI:58.5%~100%),高于对照组77.4%(95%CI:41.3%~100%)(P<0.001)。在并发症的发生率上两组差异无统计学意义(P>0.05)。结论内科胸腔镜联合尿激酶治疗包裹黏连性胸腔积液,患者胸腔积液引流量多、引流彻底、干净,积液消失快,胸膜增厚减轻,治疗效果好,且并发症无明显增加。
Objective To evaluate the efficacy of thoracoscope combined with urokinase intrapleural injection in the treatment of acute paroxysmal pleural effusion. Methods Fifty-eight patients with acute paroxysmal pleural effusion were divided into treatment group (n = 27) and control group (n = 31) according to different treatment methods. The treatment group was treated by thoracoscope. After treatment, closed thoracic drainage tube , While giving intrathoracic injection of urokinase (100,000 U) reserved for 24 to 48 h after drainage, 2 times per week (according to the drainage fluid color change frequency); control group conventional thoracic tube drainage. The drainage volume, effusion protein content, effusion disappearing time, pleural thickness, therapeutic effect and complication rate of pleural effusion in two groups were compared. Results The drainage volume of pleural effusion in treatment group was (1141.51 ± 411.66) m L, which was significantly higher than that in control group (751.93 ± 605.53) m L (P <0.05). The disappearance time of pleural effusion and pleural thickness in treatment group were (6.18 ± 1.88) d and (2.09 ± 0.50) mm respectively, which was lower than that of the control group (7.54 ± 2.28) d and (2.90 ± 0.57) mm (P <0.05). The pleural effusion protein content in the treatment group was (26.45 ± 12.09) Lower than the control group (34.33 ± 10.99) g (P <0.05). The effective rate in the treatment group was 96.3% (95% CI: 58.5% -100%), which was higher than that in the control group (77.4%; 95% CI: 41.3% -100%) (P <0.001). There was no significant difference in the incidence of complications between the two groups (P> 0.05). Conclusions The medical thoracoscopy combined with urokinase in the treatment of adhesive pleural effusion, pleural effusion more drainage, thorough draining, fluid disappear quickly, reduce pleural thickening, the treatment effect is good, and no significant increase in complications.