【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。更多还原

【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 2 HRZE/10 HR（ 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.更多还原