胸腔内注射肝素治疗结核性包裹性胸膜炎疗效观察(1)
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【摘要】
目的：观察胸腔内注入肝素治疗结核性包裹性胸膜炎的疗效。方法：69例结核性包裹性胸膜炎患者随机分为治疗组(35例)与对照组(34例)。治疗组每次充分引流后注射肝素6250U+生理盐水20ml，对照组不注药。两组抗结核方案均为2HREZ/4HR。结果治疗组显效率34.3%，对照组为8.8%，两者有显著性差异(P﹤0.01)。治疗组总有效率91.4%，对照组为79.4%，两者有显著性差异(P﹤0.01)。治疗2月后，B超观察治疗组胸膜厚度3.8±1.3mm，对照组为6.5±2.9mm，两者有显著性差异(P﹤0.01)。治疗组肺功能FVC%为(89.8±1.7)%，对照组(76.5±1.6)%(P﹤0.05)；治疗组FEV1/FVC%为(85.2±2.9)%，对照组为(74.6±2.5)%，两者差异亦有显著性(P﹤0.05)。结论：胸腔内注射肝素能减少胸膜肥厚粘连，改善肺功能，药物安全性好，是一项有效的辅助治疗措施。
【关键词】肝素；结核性包裹性胸膜炎；多房积液； 胸腔肥厚；粘连
Intrpleural injection of heparin in the treatment of tuberculous pleurisy with effusion
【Abstract】 Objective: To observe the curative effect of intrapleual heparin for tuberculous pleurisy. Method:Sixty-nine patients with tuberculous pleural effusion were randomized into two groups,treatment group and control group. The patients in the control group were injectived with heparin and 20ml physiological intrapleurally each time after thoracocentesis, and the patients in the control group injected nothing.Results: The excellence rate of treatment group and control group were 34.3% and 8.8% respectively (p<0.01),the effective rate of those were 91.4% and 79.4%(p<0.01).After two months ,the mean thickness of plaura in the treatment group was(3.8±1.3mm) by B ultrasound wave test, while it was(6.5±2.9mm) in the control group(p<0.01).The lung function (FVC%) examined was(89.8±1.7)% in the treatment group, while it was (76.5±1.6)% in the control group(p<0.05). FEV1/FVC% was(85.2±2.9)% in the treatment group, while it was(74.6±2.5)% in the control group(p<0.05). Conclusion: Intrapleural heparin can not only reduce pleural adhesion ,loculation and thickening of the pleural but also improve lung function.
【Key words】 heparin; tuberculosis; pleurisy; thickening; adhesion
【中图分类号】R104.45 【文献标识码】B 【文章编号】1005-0515(2011)10-0368-02
结核性胸膜炎渗出液中含有丰富的纤维蛋白，治疗不及时可形成纤维沉积和纤维分隔，形成包裹性积液或多房积液，可导致胸膜肥厚粘连，肋间隙变窄或胸廓畸形，影响肺功能。据相关文献报道，结核性胸膜炎发生胸膜肥厚粘连者达到30%[1]。我们通过胸腔内注入肝素治疗结核性包裹性胸膜炎，取得较好的疗效，现报告如下。
1 对象与方法
1.1 对象:
病例选择选择2008年1月至2008年12月期间在我院治疗的单侧结核性包裹性胸腔积液患者69例，随机分为2组。所有患者均符合2001年中华医学会结核病分会制定的“结核性胸膜炎”的诊断标准，并符合以下标准：①初治患者；②无心、肝、肾等脏器合并症；③血常规、凝血酶原时间(PT)、激活的部分凝血致活酶时间(APTT)测定结果正常；④经B超检查证实为单侧包裹性胸腔积液 ......
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