陈子伟　杨耿标　庄俊合

[摘要] 目的 探讨胸腔闭式引流并注入尿激酶治疗胸腔积液的效果。 方法 选择2013年1月～2014年3月来本院就诊的110例结核性胸腔积液患者作为研究对象，根据治疗方法的不同，将所有患者按随机抽样的方法分为实验组和对照组，对照组胸腔闭式引流后不作其余处理，实验组在安装胸腔闭式引流管后，在胸腔内通过引流管注射尿激酶。1个疗程后通过超声或CT确定胸腔积液程度，化验胸腔积液引流液中的成分，进行疗效评价。 结果 治疗前，两组患者胸腔积液中的蛋白质、白细胞浓度差异无统计学意义（P>0.05），实验组治疗后胸腔积液中的蛋白质、白细胞浓度较对照组均明显下降（P<0.05）。实验组的总有效率为98.2%；对照组为74.5%，两组的总有效率差异有统计学意义（P<0.05）。 结论 胸腔闭式引流并注入尿激酶治疗胸腔积液的效果明显好于传统单纯胸腔闭式引流，效果显著，值得临床推广。

[关键词] 胸腔闭式引流；尿激酶；胸腔积液

[中图分类号] R561.3 [文献标识码] A [文章编号] 1674-4721（2015）05（c）-0085-03

[Abstract] Objective To explore the effect of thoracic close drainage combined with urokinase injection treating pleural effusion. Methods From January 2013 to March 2014，110 patients with tuberculous pleural effusion treated in our hospital were selected as research objects.According to different therapeutic methods，all patients were randomly divided into experimental group and control group according to random sampling method.In control group，no further treatment was applied after thoracic closed drainage，while in experimental group，after installation of thoracic drainage tube，urokinase was injected through drainage tube.The level of pleural effusion was determined by ultrasound or CT after 1 course of treatment，and components of drainage fluid in pleural effusion was tested aiming at effect evaluation. Results Before treatment，there was no statistical difference of protein and white blood cell concentration in pleural fluid of patients in two groups （P>0.05）. After treatment，protein and white blood cell concentration in pleural fluid in experimental group was greatly decreased compared with that in control group respectively （P<0.05）.The total effective rate in experimental group was 98.2%，while in control group，the total effective rate was 74.5%，which displayed a statistical difference （P<0.05）. Conclusion Effect of thoracic close drainage combined with urokinase injection treating pleural effusion is significantly better than traditional thoracic close drainage alone.It obtains a remarkable effect，and is worthy of promotion in clinic.

[Key words] Thoracic close drainage；Urokinase；Pleural effusion

胸膜腔是位于胸壁和肺之间的一个潜在腔隙，正常人的胸膜腔内含3～15 ml的液体，这些液体主要是在肺部呼吸时发挥润滑作用，处于不断产生和吸收的交换过程中，每天都有500～1000 ml的胸腔液吸收和形成，支气管血管和胸壁血管产生液体最终被肺支气管静脉再吸收，也会通过淋巴系统将一部分液体回收到血液中，一般健康状态下处于动态平衡状态，而决定平衡状态的原因主要为胶体渗透压和流体静水压两者的压力差[1]。当机体出现异常时，胸腔液体产生与吸收的动态平衡被打破，胸腔积液产生增快而吸收减慢，形成胸腔积液，结核是引起胸腔积液的临床常见原因，传统治疗结核性胸腔积液的方法为安装胸腔闭式引流，这种方法治疗效果不佳，而且患者痛苦[2]。近……