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目的对比观察微创单腔导管进行胸腔闭式引流术与常规胸腔穿刺抽液治疗结核性胸腔积液的临床疗效。方法收集2008年12月至2012年12月在文登中心医院感染性疾病科住院的结核性胸膜炎患者共60例。患者在接受3HRZE/9HR正规口服抗结核治疗的同时,其中30例应用微创单腔静脉导管进行胸腔闭式引流,另30例采用常规胸腔穿刺抽液,对比观察两组发热消退时间、胸闷症状改善、胸水消失时间以及并发症的发生情况。结果应用微创单腔导管进行胸腔闭式引流术组,发热消失时间、胸闷症状改善时间、胸水消失时间分别为(4.7±1.4)、(1.4±0.3)和(4.10±1.31)d,而穿刺抽液组对应分别为(9.5±2.3)、(4.5±1.2)和(13.56±2.11)d,两组间比较差异均有统计学意义(P<0.01)。在并发症方面,导管引流组3例(10%)出现胸膜增厚,1例(3.3%)出现包裹性胸腔积液,未发生血胸、气胸及胸膜反应;穿刺抽液组18例(60%)出现胸膜增厚,12例(40%)出现包裹性胸腔积液,血胸、气胸和胸膜反应各3例。两组各种并发症的发生率比较差异有统计学意义(P<0.01)。结论采用微创单腔导管进行胸腔引流术治疗结核性胸腔积液症状改善快,并发症发生率低,患者依从性好,值得临床推广应用。
Objective To compare the clinical efficacy of minimally invasive single-lumen catheter for thoracic drainage and conventional thoracentesis for the treatment of tuberculous pleural effusion. Methods A total of 60 patients with tuberculous pleurisy were admitted to Department of Infectious Diseases, Wendeng Central Hospital from December 2008 to December 2012. Thirty patients underwent standard thoracic drainage with minimally invasive single vena cava venous catheter while the patients received formal oral anti-TB therapy of 3HRZE / 9HR. The other 30 patients were treated with conventional thoracentesis, and the comparison of fever subsidence time, chest tightness symptoms Improvement, disappearance of pleural effusion, and the incidence of complications. Results Minimally invasive single-lumen catheters were used for thoracic drainage. The duration of disappearance of fever, improvement of chest tightness, and disappearance of pleural effusion were (4.7 ± 1.4), (1.4 ± 0.3) and (4.10 ± 1.31) days, respectively. The corresponding rates of the two groups were (9.5 ± 2.3), (4.5 ± 1.2) and (13.56 ± 2.11) d, respectively. There was significant difference between the two groups (P <0.01). In complication, pleural thickening was found in 3 cases (10%) in catheter drainage group and encapsulated pleural effusion in 1 case (3.3%). No hemothorax, pneumothorax and pleural reaction occurred in 18 cases (60 %) Pleural thickening, pleural effusion in 12 cases (40%), hemothorax, pneumothorax and pleural reaction in 3 cases. The incidence of various complications in the two groups was significantly different (P <0.01). Conclusion Minimally invasive single-lumen catheter for chest drainage for the treatment of tuberculous pleural effusion symptoms improved rapidly, the incidence of complications is low, patients with good compliance, is worthy of clinical application.