CAJ | 학술논문

目的探讨结核性胸膜炎应用过氧化氢溶液冲洗联合聚维酮碘溶液局部胸腔灌注治疗的方法和疗效.方法 B超或64排螺旋CT定位后,先用内科胸腔镜检查胸腔抽尽积液,并剪断或用高频电刀切断胸腔内粘连,然后用3％过氧化氢溶液200 ml冲洗胸腔,最后不断用0.5％聚维酮碘溶液灌注,以尽快控制腔内感染,促进愈合,常规抗结核治疗1年,观察胸腔积液消失时间和胸膜肥厚状况.结果共86例患者参与,48例在抗结核同时予以胸腔穿刺抽胸腔积液治疗,有22例患者治疗4周胸腔积液基本未再增加,予以停止胸腔穿刺继续抗结核治疗(第1组),余下26例患者接着接受过氧化氢溶液冲洗联合聚维酮碘溶液局部胸腔灌注治疗(第2组),有23例患者1周内达到治疗目的,有效率88.46％(23/26).第3组38例患者未行胸腔穿刺直接接受过氧化氢溶液冲洗联合聚维酮碘溶液局部胸腔灌注治疗,有36例1周内达到治疗目的,有效率94.74％ (36/38).胸腔积液消失时间第3组明显短于第1组(1周比4周)(P＜0.05),第2组与第3组有效率比较差异无统计学意义(P＞0.05).半年后测量胸膜厚度发现第1组胸膜最厚,第3组最薄,有的甚至未发现胸膜肥厚.1年后亦如此.结论过氧化氢溶液冲洗联合聚维酮碘溶液局部胸腔灌注治疗结核性胸膜炎的方法,疗效确切,可缩短胸腔积液消失时间,减轻胸膜肥厚.
목적 탐토결핵성흉막염응용과양화경용액충세연합취유동전용액국부흉강관주치료적방법화료효.방법 B초혹64배라선CT정위후,선용내과흉강경검사흉강추진적액,병전단혹용고빈전도절단흉강내점련,연후용3％과양화경용액200 ml충세흉강,최후불단용0.5％취유동전용액관주,이진쾌공제강내감염,촉진유합,상규항결핵치료1년,관찰흉강적액소실시간화흉막비후상황.결과 공86례환자삼여,48례재항결핵동시여이흉강천자추흉강적액치료,유22례환자치료4주흉강적액기본미재증가,여이정지흉강천자계속항결핵치료(제1조),여하26례환자접착접수과양화경용액충세연합취유동전용액국부흉강관주치료(제2조),유23례환자1주내체도치료목적,유효솔88.46％(23/26).제3조38례환자미행흉강천자직접접수과양화경용액충세연합취유동전용액국부흉강관주치료,유36례1주내체도치료목적,유효솔94.74％ (36/38).흉강적액소실시간제3조명현단우제1조(1주비4주)(P＜0.05),제2조여제3조유효솔비교차이무통계학의의(P＞0.05).반년후측량흉막후도발현제1조흉막최후,제3조최박,유적심지미발현흉막비후.1년후역여차.결론 과양화경용액충세연합취유동전용액국부흉강관주치료결핵성흉막염적방법,료효학절,가축단흉강적액소실시간,감경흉막비후.
Objective To evaluate the effectiveness of treating tuberculous pleurisy with hydrogen peroxide solution washing and povidone iodine solution perfusing topically.Methods After fixing position with B ultrasound or 64 rows spiral computed tomography,the thoracic cavity was firstly inspected with thoracoscope,the effusion was exhausted and the conglutionations was cut with thoracoscope or high frequency electrome,then the thoracic cavity was washed with 200 ml 3％ hydrogen peroxide solution,and lastly it was perfused continually with 0.5％ povidone iodine solution to control the intracavity infection quickly and to promote cicatrization.After routine antitubercular therapy for one year,the time of pleural effusion disappearing and the state of pleura hypertrophy was observed.Results There were 86 cases in all.After antitubercular therapy and extracting pleural effusion at the same time in 48 cases.Twenty-two cases'effusion didn't increase basically after 4 weeks.They stopped extracting effusion and went on with antitubercular therapy (the first group).The rest 26 patients continued to accept the therapy of hydrogen peroxide solution washing and povidone iodine solution perfusing topically (the second group),and 23cases achieved remedial goal in a week with the effective rate of 88.46％ (23/26).The third group had 38 cases who didn't accept thoracocentesis but accepted the therapy of hydrogen peroxide solution washing and povidone iodine solution perfusing directly,and there were 36 cases that achieved remedial goal in a week with effective rate of 94.74％ (36/38).The time of pleural effusion disappearing in the third group was obviously shorter than that in the first group (1 week vs.4 weeks )(P ＜ 0.05 ),and there was no significant difference in the efftective rate between the second group and the third group (P ＞ 0.05 ).Half a year after therapy,the thickness of pleura was measured and it was found that in the first group was thickest and in the third group thinnest and even some without hypertrophy.It was the same effect after one year.Conclusions The effectiveness of the method treating tuberculous pleurisy with hydrogen peroxide solution washing and povidone iodine solution perfusing topically is defimite,and the method can shorten the time of pleural effusion disappearing and alleviate the pleural hypertrophy.