[1]崔俊伟,王永亮,蔡瑞艳,等.中心静脉导管胸腔闭式引流联合超声引导靶位给药治疗结核性胸膜炎疗效观察[J].新乡医学院学报,2018,35(5):400-403.[doi:10.7683/xxyxyxb.2018.05.011]
　CUI Jun-wei,WANG Yong-liang,CAI Rui-yan,et al.Clinical effect of central venous catheter thoracic drainage combined with ultrasound guided target therapy in treating patients with tuberculous pleurisy[J].Journal of Xinxiang Medical University,2018,35(5):400-403.[doi:10.7683/xxyxyxb.2018.05.011]
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中心静脉导管胸腔闭式引流联合超声引导靶位给药治疗结核性胸膜炎疗效观察
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
35
期数:
2018年5
页码:
400-403
栏目:
临床研究
出版日期:
2018-05-05

文章信息/Info

Title:
Clinical effect of central venous catheter thoracic drainage combined with ultrasound guided target therapy in treating patients with tuberculous pleurisy
作者:
崔俊伟; 王永亮; 蔡瑞艳; 崔秀琴; 李振云; 张春晓; 高景利
（新乡医学院第一附属医院结核内一科，河南　卫辉　453100）
Author(s):
CUI Jun-wei; WANG Yong-liang; CAI Rui-yan; CUI Xiu-qin; LI Zhen-yun; ZHANG Chun-xiao; GAO Jing-li
（The First Department of Tuberculosis，the First Affiliated Hospital of Xinxiang Medical University，Weihui 453100，Henan Province，China）
关键词:
靶位给药; 超声引导; 结核性胸膜炎; 肺功能; 胸膜厚度
Keywords:
target drug delivery; ultrasound guided; tuberculous pleurisy; pulmonary function; pleural thickness
分类号:
R561.1
DOI:
10.7683/xxyxyxb.2018.05.011
文献标志码:
A
摘要:
目的　探讨中心静脉导管胸腔闭式引流联合超声引导靶位给药治疗结核性胸膜炎的临床疗效。方法　将2015年3月至2017年3月新乡医学院第一附属医院收治的216例结核性胸膜炎患者分为对照组和观察组，每组108例。对照组患者给予标准抗结核化学治疗方案2HRZE/10HR（H：异烟肼，R：利福平，Z：吡嗪酰胺，E：乙胺丁醇）和中心静脉导管胸腔闭式引流治疗，观察组患者在对照组治疗的基础上联合超声引导靶位给药治疗，疗程为2个月。比较2组患者治疗前后动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、第1秒用力呼气量（FEV1）、FEV1/用力肺活量（FVC）、最大呼吸压（MEP）、最大吸气压（MIP）及胸膜厚度，并观察2组患者的临床疗效及不良反应。结果　2组患者治疗前PaO2、PaCO2、FEV1、FEV1/FVC、MEP、MIP比较差异均无统计学意义（t=0.728、0.203、0.192、0.119、0.927、0.867，P>0.05）。2组患者治疗后PaO2、FEV1、FEV1/FVC、MEP及MIP显著高于治疗前（对照组：t=2.907、2.736、2.357、3.825、3.071，P<0.05；观察组：t=3.182、4.165、3.263、7.397、5.105，P<0.05），PaCO2显著低于治疗前（对照组：t=2.587，P<0.05；观察组：t=3.712，P<0.05）。治疗后观察组患者PaO2、FEV1、FEV1/FVC、MEP及MIP显著高于对照组（t=2.753、2.899、2.282、5.367、3.229，P<0.05），PaCO2显著低于对照组（t=2.522，P<0.05）。2组患者治疗前胸膜厚度比较差异无统计学意义（t=0.632，P>0.05）；2组患者治疗后胸膜厚度显著小于治疗前（t=2.592、4.196，P<0.05），且治疗后观察组患者胸膜厚度显著小于对照组（t=2.973，P<0.05）。对照组和观察组患者治疗总有效率分别为85.2%（92/108） 和93.5%（101/108），观察组患者治疗总有效率显著高于对照组（χ2=3.941，P<0.05）。对照组患者治疗后胸膜粘连发生率为44.4%（48/108），胸膜包裹发生率为35.2%（38/108）；观察组患者治疗后胸膜粘连发生率为17.6%（19/108），胸膜包裹发生率为13.9%（15/108）；观察组患者治疗后胸膜粘连和胸膜包裹的发生率均显著低于对照组（χ2=18.201、13.230，P<0.01）。结论　中心静脉导管胸腔闭式引流联合超声引导靶位给药能够进一步改善患者的肺功能，减小胸膜厚度，降低胸膜粘连及胸膜包裹发生率。
Abstract:
Objective　To explore the clinical effect of central venous catheter thoracic drainage combined with ultrasound guided target therapy in treating patients with tuberculous pleurisy.Methods　Two hundred and sixteen patients with tuberculous pleurisy in the First Affiliated Hospital of Xinxiang Medical University from March 2015 to March 2017 were selected and divided into control group and observation group，with 108 cases in each group.The patients in the control group were treated with the unified standard chemotherapy regimen of 2HRZE/10HR（H：isoniazide，R：rifampicin，Z：pyrazinamide，E：ethambutol） for tuberculous pleurisy and central venous catheter thoracic drainage.On the basis of the treatment of the control group，the patients in the observation group were given ultrasound guided target therapy；two months was a course.The arterial oxygen partial pressure（PaO2），partial pressure of carbon dioxide in artery（PaCO2），forced expiratory volume in one second（FEV1），FEV1/ forced vital capacity（FVC），maximum expiratory pressure（MEP），maximum inspiratory pressure（MIP） and pleural thickness were compared before and after treatment between the two groups.The clinical efficacy and adverse reaction were observed in the two groups.Results　There was no significant difference in the level of PaO2，PaCO2，FEV1，FEV1/FVC，MEP and MIP between the two groups before treatment（t=0.728，0.203，0.192，0.119，0.927，0.867；P>0.05）.After treatment，the levels of PaO2，FEV1，FEV1/FVC，MEP and MIP in the two groups were higher than those before treatment（control group：t=2.907，2.736，2.357，3.825，3.071；P<0.05.observation group：t=3.182，4.165，3.263，7.397，5.105；P<0.05），and the level of PaCO2 was lower（control group：t=2.587,P<0.05;observation group：t=3.712,P<0.05）.The level of PaO2，FEV1，FEV1/FVC，MEP and MIP in the observation group was higher，and the level of PaCO2 was lower than that in the control group（t=2.753，2.899，2.282，5.367，3.229，2.522；P<0.05）.There was no significant difference in the pleural thickness between the two groups before treatment （t=0.632，P>0.05）.The pleural thickness in the two groups after treatment was thinner than that before treatment（t=2.592，4.196；P<0.05）.And the pleural thickness in the observation group after treatment was thinner than that in the control group（t=2.973，P<0.05）.The total effective rate of the control group and observation group was 85.2%（92/108） and 93.5%（101/108），respectively.The total effective rate of the observation group was higher than that in the control group（χ2=3.941，P<0.05）.The occurrence rate of pleural adhesions and pleural parcel in the control group was 44.4%（48/108） and 35.2%（38/108），while it was 17.6%（19/108） and 13.9%（15/108）in the observation group.The occurrence rate of pleural adhesions and pleural parcel in the observation group was lower than that in the control group（χ2=18.201，13.230；P<0.01）.Conclusion　Central venous catheter thoracic drainage combined with ultrasound guided target penetration therapy can further improve lung function and reduce pleural thickness，and reduce the incidence of pleural adhesions and parcel.

参考文献/References:

［1］　席秀娥，王霞，万勇敢，等.超声引导下胸膜活检术对不明原因渗出性胸腔积液的诊断价值［J］.新乡医学院学报，2015，32（7）：629-631.
［2］　CASALLAS-RIVERA M A，CRDENAS BERNAL A M，GIRALDO-CADVID L F，et al.Real-time PCR assay for the diagnosis of pleural tuberculosis［J］.Colomb Med （Cali），2017，48（2）：47-52.
［3］　ASHFAQ U A，RIAZ M，YASMEEN E，et al.Recent advances in nanoparticle-based targeted drug-delivery systems against cancer and role of tumor microenvironment［J］.Crit Rev Ther Drug Carrier Syst，2017，34（4）：317-353.
［4］　戴建义，苏菲菲，杨守峰，等.强化期联合静脉给药治疗支气管结核效果观察［J］.中国乡村医药，2014，21（14）：3-4.
［5］　胡耀，宋锁言，张艳芳，等.抗结核药物联合胸腺肽对老年结核性胸膜炎的治疗效果及对炎性因子的影响［J］.医学综述，2016，22（21）：4354-4357.
［6］　FIGUEROA-PARRA G，DE-LEN-IBARRA A L，ORIZAGA-Y-QUIROGA T L，et al.Transudative chylothorax and pleural tuberculosis in a patient with Eisenmenger syndrome：an extraordinary coincidence［J］.Lung India，2017，34（5）：481-483.
［7］　李兴.胸腔内注入尿激酶治疗结核性胸膜炎48例疗效研究［J］.基层医学论坛，2015（7）：914-915.
［8］　SHEN Y，YANG T，JIA L，et al.A potential role for D-dimer in the diagnosis of tuberculous pleural effusion［J］.Eur Rev Med Pharmacol Sci，2013，17（2）：201-205.
［9］　CAO G Q，LI L，WANG Y B，et al.Treatment of free-flowing tuberculous pleurisy with intrapleural urokinase［J］.Int J Tuberc Lung Dis，2015，19（11）：1395-1400.
［10］　张建江，陈莹华，窦文杰，等.单纯引流与联合尿激酶治疗儿童肺炎旁胸腔积液的比较［J］.中华实用儿科临床杂志，2016，31（17）：1329-1331.
［11］　RTHLISBERGER P，GASSE C，HOLLENSTEIN M.Nucleic acid aptamers：emerging applications in medical imaging，nanotechnology，neurosciences，and drug delivery［J］.Int J Mol Sci，2017，18（11）：E2430.
［12］　NALWA H S.A special issue on reviews in nanomedicine，drug delivery and vaccine development［J］.J Biomed Nanotechnol，2014，10（9）：1635-1640.

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更新日期/Last Update: 2018-05-05