超声在尿激酶注射溶解结核性胸腔积液纤维分隔中的应用价值
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摘要
目的通过超声观察尿激酶胸腔内注射对结核性胸腔积液中纤维条索分隔的溶解效果,探讨尿激酶溶解胸腔积液中纤维条索分隔的时间规律及最佳引流时间节点。方法选取临床确诊为结核性胸膜炎合并胸腔积液,且积液中有纤维条索影响引流效果的患者147例,所有患者均在超声引导下置管术引流不畅后随即注入尿激酶20万单位,根据药物注射后充分引流量将患者分为A组(充分引流量≤500 ml)48例,B组(充分引流量500～800 ml)63例,C组(充分引流量≥800 ml)36例。通过超声检查分析注药前,注药后0.5 h、1.0 h、1.5 h、2.0 h、2.5 h、3.0 h不同时间节点胸腔积液中分隔腔隙数及溶解率的变化,并进行统计分析。结果 147例患者胸腔积液纤维分隔腔隙数在药物注射不同时间节点比较,总体差异有统计学意义(F=34.989,P=0.000),其中注药前与注药后1.0 h比较,差异有统计学意义(t=6.274,P=0.000),注药后0.5 h和1.0 h比较,差异有统计学意义(t=3.300,P=0.001),注药后1.0 h与1.5 h、2.0 h、2.5 h、3.0 h分别比较,差异均无统计学意义(P均> 0.05)。A、B、C 3组注药后1.0 h与注药前、注药后0.5 h比较,差异均有统计学意义(与注药前比较:t=-6.020、-4.331、8.554,与注药后0.5 h比较:t=-3.338、2.613、5.216,P均<0.05),注药后1.0 h与1.5 h、2.0 h、2.5 h、3.0 h分别比较,差异均无统计学意义(P均> 0.05)。结论 20万单位尿激酶注射1.0 h内胸腔积液中纤维条索分隔腔隙溶解速度最快,注射1.0 h后溶解效果不明显。超声作为实时观察胸腔内纤维分隔溶解变化的一种有效方法,值得临床推广应用。
Objective To observe the effect of intrathoracic injection of urokinase on the separation of ?brous septa in the pleural effusion of patients with tuberculous pleurisy treated by ultrasound,and to explore the time rule and optimal drainage time node of ?brin strip separation in urokinase-dissolved pleural effusion. Methods A total of 147 patients with tuberculous pleurisy and pleural effusion with ?ber strips in?uencing the drainage were selected. According to the full drainage volume on the day, 48 cases were divided into group A(fully diverted ?ow ≤ 500 ml), 63 cases in group B(fully diverted ?ow 500～800 ml),and 36 cases in group C(fully diverted ?ow ≥ 800 ml). All of them were injected with 200,000 units of urokinase. Then we analyzed the images under the guidance of ultrasound at the time points of before injection, and 0.5 h, 1.0 h, 1.5 h, 2.0 h, 2.5 h and 3.0 h after injection. The changes of the number of ?brous septa in pleural effusion at different time points were analyzed. Results After drug injection, the number of pleural effusion ?bers in the 147 patients was compared at different time points, and there was a statistically difference(F=34.989, P=0.000). There was a statistical difference between before injection and 1.0 h after injection(t=6.274, P=0.000). There was a statistical difference between 0.5 h and 1.0 h after injection(t=3.300,P=0.001). There was no statistical difference between 1.0 h and 1.5 h, 2.0 h, 2.5 h, 3.0 h after injection(P > 0.05). There were statistical differences between 1.0 h after injection in group A, B and C, and 0.5 h before injection and 0.5 h after injection(pre-drug comparison: t=-6.020,-4.331, 8.554; compared with 0.5 h after injection: t=-3.338, 2.613, 5.216; all P < 0.05). There was no statistical difference between 1.0 h and1.5 h, 2.0 h, 2.5 h, and 3.0 h after injection(all P > 0.05). Conclusion After injection of 200,000 units of urokinase, the fastest dissolution rate of ?brous septa in pleural effusion achieved with the ?rst hour, and the dissolution effect was not obvious at 1.5 h after injection. Ultrasound is an effective method to observe the changes of ?brous septa dissolution in thoracic cavity in real time, and is worthy of clinical application.
Objective To observe the effect of intrathoracic injection of urokinase on the separation of ?brous septa in the pleural effusion of patients with tuberculous pleurisy treated by ultrasound,and to explore the time rule and optimal drainage time node of ?brin strip separation in urokinase-dissolved pleural effusion. Methods A total of 147 patients with tuberculous pleurisy and pleural effusion with ?ber strips in?uencing the drainage were selected. According to the full drainage volume on the day, 48 cases were divided into group A(fully diverted ?ow ≤ 500 ml), 63 cases in group B(fully diverted ?ow 500～800 ml),and 36 cases in group C(fully diverted ?ow ≥ 800 ml). All of them were injected with 200,000 units of urokinase. Then we analyzed the images under the guidance of ultrasound at the time points of before injection, and 0.5 h, 1.0 h, 1.5 h, 2.0 h, 2.5 h and 3.0 h after injection. The changes of the number of ?brous septa in pleural effusion at different time points were analyzed. Results After drug injection, the number of pleural effusion ?bers in the 147 patients was compared at different time points, and there was a statistically difference(F=34.989, P=0.000). There was a statistical difference between before injection and 1.0 h after injection(t=6.274, P=0.000). There was a statistical difference between 0.5 h and 1.0 h after injection(t=3.300,P=0.001). There was no statistical difference between 1.0 h and 1.5 h, 2.0 h, 2.5 h, 3.0 h after injection(P > 0.05). There were statistical differences between 1.0 h after injection in group A, B and C, and 0.5 h before injection and 0.5 h after injection(pre-drug comparison: t=-6.020,-4.331, 8.554; compared with 0.5 h after injection: t=-3.338, 2.613, 5.216; all P < 0.05). There was no statistical difference between 1.0 h and1.5 h, 2.0 h, 2.5 h, and 3.0 h after injection(all P > 0.05). Conclusion After injection of 200,000 units of urokinase, the fastest dissolution rate of ?brous septa in pleural effusion achieved with the ?rst hour, and the dissolution effect was not obvious at 1.5 h after injection. Ultrasound is an effective method to observe the changes of ?brous septa dissolution in thoracic cavity in real time, and is worthy of clinical application.
引文
1彭德虎,林兆原,石琳,等.B超检查对结核性胸膜炎患者胸腔尿激酶注入疗效评估的分析[J].中国防痨杂志,2011,33(6):369-371.
2朱贵朝.肝素或不同剂量尿激酶对结核包裹性胸腔积液临床疗效的对比研究[J/CD].中华肺部疾病杂志(电子版),2012,5(1):41-45.
3裴胜利.尿激酶胸腔内注入治疗结核性包裹性胸腔积液52例疗效观[J].中国煤炭工业医学杂志,2010,13(3):364.
4包小华,赵婉华,乔向亮,等.胸腔注射尿激酶治疗结核性包裹性胸腔积液疗效观察[J].疑难病杂志,2005,4(2):100-101.
5聂琦,陶立轩,袁冶,等.尿激酶治疗结核性包裹性胸腔积液临床效果的Meta分析[J].解放军医药杂志,2015,28(11):94-98.
6厉银平,刘桂霞,彭清臻,等.尿激酶在体外溶解纤维条索的观察研究[J].临床肺科杂志,2013,18(7):1339-1358.
7陈红军,陈成水.尿激酶溶解纤维条索的初步观察[J].医药导报,2011,30(1):19-21.
8唐先梅,赵英仁,江自成,等.新方法初治结核性胸膜炎的疗效观察[J].中国感染控制杂志,2018,17(1):52-55.
9林明贵,黎晓林,张广宇,等.超声引导下胸腔穿刺抽液并注入尿激酶治疗结核性包裹性胸腔积液[J].临床肺科杂志,2009,14(4):469-471.
10 Cases Viedma E,Lorenzo Dus MJ,González-Molina A,et al.A study of loculated tuberculous pleural effusions treated with intrapleural urokinase[J].Respir Med,2006,100(11):2037-2042.
11蒋慧,朱林萍.结核性渗出性胸膜炎治疗进展[J].中华全科医学,2011,9(2):273-274.
12任斐,毛晓辉.结核性渗出性胸膜炎的治疗进展[J].吉林医学,2012,33(8):1668-1670.
2朱贵朝.肝素或不同剂量尿激酶对结核包裹性胸腔积液临床疗效的对比研究[J/CD].中华肺部疾病杂志(电子版),2012,5(1):41-45.
3裴胜利.尿激酶胸腔内注入治疗结核性包裹性胸腔积液52例疗效观[J].中国煤炭工业医学杂志,2010,13(3):364.
4包小华,赵婉华,乔向亮,等.胸腔注射尿激酶治疗结核性包裹性胸腔积液疗效观察[J].疑难病杂志,2005,4(2):100-101.
5聂琦,陶立轩,袁冶,等.尿激酶治疗结核性包裹性胸腔积液临床效果的Meta分析[J].解放军医药杂志,2015,28(11):94-98.
6厉银平,刘桂霞,彭清臻,等.尿激酶在体外溶解纤维条索的观察研究[J].临床肺科杂志,2013,18(7):1339-1358.
7陈红军,陈成水.尿激酶溶解纤维条索的初步观察[J].医药导报,2011,30(1):19-21.
8唐先梅,赵英仁,江自成,等.新方法初治结核性胸膜炎的疗效观察[J].中国感染控制杂志,2018,17(1):52-55.
9林明贵,黎晓林,张广宇,等.超声引导下胸腔穿刺抽液并注入尿激酶治疗结核性包裹性胸腔积液[J].临床肺科杂志,2009,14(4):469-471.
10 Cases Viedma E,Lorenzo Dus MJ,González-Molina A,et al.A study of loculated tuberculous pleural effusions treated with intrapleural urokinase[J].Respir Med,2006,100(11):2037-2042.
11蒋慧,朱林萍.结核性渗出性胸膜炎治疗进展[J].中华全科医学,2011,9(2):273-274.
12任斐,毛晓辉.结核性渗出性胸膜炎的治疗进展[J].吉林医学,2012,33(8):1668-1670.