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目的探讨胸腔留置中心静脉导管治疗渗出性结核性胸膜炎的临床应用价值及可行性。方法对2005年1月—2010年10月100例结核性胸膜炎伴发中至大量胸腔积液患者随机分组,分为治疗组50例和对照组50例。在规范抗结核药物治疗基础上,治疗组采用中心静脉导管置入胸膜腔持续引流胸腔积液治疗,对照组采用传统间断胸腔穿刺抽水治疗。观察比较两组的平均住院天数、胸水吸收时间、发热消退时间、治疗3月后胸膜厚度及并发症发生率(胸水包裹、复张性肺水肿、胸膜反应、气胸)。结果胸水吸收时间、发热消退时间治疗组比对照组缩短,治疗后第3月胸膜厚度治疗组比对照组减少,并发症发生率治疗组比对照组明显降低。结论采用胸腔留置中心静脉导管治疗结核性胸膜炎,方法简单、易操作、创伤小、效果好,值得临床推广。
Objective To investigate the clinical value and feasibility of pleural indwelling central venous catheter in the treatment of exudative tuberculous pleurisy. Methods From January 2005 to October 2010, 100 patients with tuberculous pleurisy with moderate to large pleural effusion were randomly divided into treatment group (50 cases) and control group (50 cases). On the basis of standard anti-tuberculosis drug treatment, the treatment group was treated with continuous drainage of pleural effusion by central venous catheter and the control group by conventional intermittent thoracentesis. The mean duration of hospital stay, pleural effusion time, fever subsided time, pleural thickness and incidence of complications after 3 months of treatment were compared between the two groups (pleural effusion, recurrent pulmonary edema, pleural reaction, pneumothorax). Results The time of pleural effusion and the subsided time of fever were shorter in the treatment group than in the control group. The pleural thickness in the third month after treatment was lower in the treatment group than in the control group, and the incidence of complications was significantly lower in the treatment group than in the control group. Conclusions The treatment of tuberculous pleurisy with thoracic central venous catheter is simple, easy to operate, less invasive and effective and worthy of clinical promotion.