李啸　徐静

[摘要] 目的 研究肺癌與肺炎合并伴胸腔积液患者的急诊疗效及血浆B型钠尿肽（BNP）、降钙素原（PCT）水平的变化情况。 方法 选取2015年5月～2017年5月重庆市高新区人民医院收治的肺癌合并胸腔积液患者52例记为肺癌组，另取同期收治的肺炎合并胸腔积液患者52例记为肺炎组。两组患者均予以强心、利尿、抗炎、抗感染以及控制液体出入量治疗。分别于治疗前以及治疗7 d后行胸部CT扫描，观察两组患者肺炎治疗效果、胸腔积液治疗效果、治疗前后血浆BNP与PCT水平变化情况。 结果 肺炎组肺炎总有效率为96.15%，肺癌组为82.69%（P > 0.05）。肺炎组胸腔积液治疗总有效率为84.62%，肺癌组44.23%（P < 0.05）。治疗后肺炎组血浆BNP与PCT水平均显著低于本组治疗前，而肺癌组血浆PCT水平显著低于本组治疗前，差异均有统计学意义（P < 0.05）。 结论 相比于肺癌合并胸腔积液，临床常规的强心、抗炎、抗感染以及控制液体出入量等更适于治疗肺炎合并胸腔积液患者，可有效改善患者的心功能，减轻炎性反应。

[关键词] 胸腔积液；肺癌；肺炎；降钙素原；B型钠尿肽

[中图分类号] R561；R734 [文献标识码] A [文章编号] 1673-7210（2018）09（b）-0121-04

[Abstract] Objective To compare the emergency curative effect and the changes of plasma B-type natriuretic peptide （BNP） and procalcitonin （PCT） levels between lung cancer and pneumonia with pleural effusion patients. Methods A total of 52 patients with lung cancer with pleural effusion admitted to the People′s Hospital of Gaoxin District in Chongqing City from May 2015 to May 2017 were selected as lung cancer group； and 52 patients with pneumonia with pleural effusion were selected as pneumonia group during the same period. Two groups of patients were treated with strengthening the heart， diuresis， anti-inflammatory， anti-infection and limiting fluid intake therapies. The chest CT scan was conducted before the treatment and 7 days after treatment. The therapeutic effect of pneumonitis， pleural effusion and plasma PCT and BNP levels before and after treatment were observed between the two groups. Results The total effective rate of pneumonia treatment in the pneumonia group and the lung cancer group was 96.15% and 82.69%， respectively（P > 0.05）. The total effective rate of pleural effusion in the pneumonia group and the lung cancer group was 84.62% and 44.23%， respectively（P < 0.05）. The plasma BNP and PCT levels of patients in pneumonia group after treatment were significantly lower than those before treatment， while the plasma PCT level in lung cancer group after treatment was significantly lower than that before treatment （P < 0.05）. Conclusion In contrast to the patients with lung cancer with pleural effusion， the clinical conventional treatments， such as strengthening the heart， diuresis， anti-inflammatory， anti-infection and limiting fluid intake， are more suitable in the treatment for patients with pneumonia with pleural effusion， which can effectively improve heart function and relieve inflammatory response.

[Key words] Pleural effusion； Lung cancer； Pneumonia； Procalcitonin； B-type natriuretic peptide

肺炎主要是指由细菌、真菌以及病毒等致病微生物和吸入性异物等因素导致的终末气道肺泡与肺间质的炎症，患者临床主要症状表现包括发热、咳嗽、咳痰等，部分患者还伴有胸痛以及呼吸困难等症状[1]。且有研究报道显示，肺炎患者通常会合并胸腔积液，从而使得病情加重，进一步导致针对性治疗的难度加大，最终在一定程度上延长了患者的住院治疗时间，增加了死亡率[2]。而肺癌患者处于中晚期时通常会出现肺癌合并胸腔积液，从而促使患者呼吸困难以及循环障碍，对患者的生活质量具有严重影响[3]。因此，在临床治疗肺炎与肺癌的过程当中，应先对患者的胸腔积液进行有效的控制，以便治疗后稳定病情，降低死亡风险[4]。鉴……