目的 比較胸腔內(nèi)注入肝素、尿激酶或生理鹽水對(duì)預(yù)防和治療結(jié)核性胸膜炎引起胸膜增厚和粘連的效果。方法 60 例結(jié)核性胸膜炎患者隨機(jī)分為3 組, 每組20 例, 分別于胸腔內(nèi)注入肝素( 肝素組) 、尿激酶( 尿激酶組) 和生理鹽水( 對(duì)照組) 。治療前后分別測(cè)定胸腔積液的纖維蛋白原和D-二聚體含量。記錄胸腔積液引流量和吸收時(shí)間, 治療2 個(gè)月后胸膜厚度和胸膜粘連的發(fā)生率。結(jié)果 肝素組注射72 h 后胸腔積液中纖維蛋白原的含量較治療前明顯升高[ ( 1. 13 ±0. 44) g /L比( 0. 34 ±0. 19) g/L, P lt; 0. 001) , 尿激酶組明顯降低[ ( 0.25 ±0. 16) g/L 比( 0.38 ±0. 15) g/L, P lt;0. 05] 。胸腔內(nèi)注入肝素或尿激酶后胸腔積液中D-二聚體含量均顯著升高[ ( 57.0 ±17. 6) mg /L 比( 40. 0 ±15. 4) mg/L, P lt;0. 05; ( 74. 5 ±16. 4) mg/L 比( 43. 8 ±14. 9) mg /L, P lt; 0. 001] 。胸腔積液吸收時(shí)間3 組間無顯著差異( P gt; 0. 05) ; 肝素組和尿激酶組胸腔積液引流量較對(duì)照組顯著增多( 2863 mL、2465 mL 比1828 mL, P lt;0. 01) , 其中肝素組比尿激酶組顯著增多( P lt;0. 01) 。治療2 個(gè)月后, 肝素組及尿激酶組壁層胸膜較對(duì)照組明顯變薄[ ( 1.37 ±0. 82) mm、( 1. 33 ±0. 85) mm比( 3. 06 ±1. 20) mm, P lt;0. 01] , 胸膜粘連發(fā)生率亦明顯低于對(duì)照組( 15%、20% 比50% , P lt;0. 05) 。結(jié)論 胸腔內(nèi)注入肝素預(yù)防和治療結(jié)核性胸膜炎的胸膜增厚和粘連的療效與尿激酶相似, 明顯優(yōu)于生理鹽水。由于肝素價(jià)廉、藥源充足和安全性好, 可作為預(yù)防和治療結(jié)核性胸腔積液并發(fā)癥的一線藥物。
引用本文： 黃炎明,謝燦茂,左萬里. 胸腔內(nèi)注入肝素或尿激酶治療結(jié)核性胸膜炎的臨床對(duì)比研究. 中國(guó)呼吸與危重監(jiān)護(hù)雜志, 2009, 09(3): 247-250. doi: 復(fù)制
| 1. | Laisaar T, Puttsepp E, Laisaar V, et al. Early administration of intrapleural streptokinase in the treatment of multiloculated pleaural effusions and pleural empyemas. Thorac Cardiovasc Surg, 1996, 44 :252-256. |
| 2. | 呂友堤, 陳平, 徐敏. 測(cè)定胸液中D-二聚體含量的臨床意義. 湖南醫(yī)科大學(xué)學(xué)報(bào), 2000, 25: 71-72. |
| 3. | Cochran JB, Tecklenburg FW, Turner RB. Intrapleural instillation of fibrinolytic agents for treatment of pleural empyema. Pediatr Crit Care Med, 2003, 4: 39-43. |
| 4. | Basile A, Boullosa-Seoane E, Dominguez Viguera L, et al.Intrapleural fibrinolysis in the management of empyemas and haemothoraces. Our experience. Radiol Med, 2003, 105: 12-16. |
| 5. | 姜軼飛, 程海英, 姚楊偉. 胸腔內(nèi)注射肝素防治包裹性胸腔積液. 臨床醫(yī)學(xué), 2007, 27: 57. |
| 6. | Park CS, Chung WM, Lim MK, et al. Transcatheter instillation of urokinase into loculated pleural effusion: analysis of treatment effect. Am J Roentgenol, 1996, 167: 649-652. |
| 7. | Kornecki A, Sivan Y. Treatment of loculated pleural effusion with intrapleural urokinase in children. J Pediatr Surg, 1997, 32: 1473 -1475. |
| 8. | Kwak SM, Park CS, Cho JH, et al. The effects of urokinase instillation therapy via percutaneous transthoracic catheter inloculated tuberculous pleural effusion: a randomized prospective study. Yonsei Med J, 2004, 45: 822-828. |
| 9. | 黃秀云. 肝素鈉胸腔內(nèi)注入治療結(jié)核性滲出性胸膜炎的臨床觀察. 臨床薈萃, 2006, 21: 1041-1042. |
| 10. | Strange C, Baumann MH, Sahn SA, et al. Effects of intrapleural heparin or urokinase on the extent of tetracycline-induced pleural disease. Am J Respir Crit Care Med, 1995, 151: 508-515. |
| 11. | 李家增, 賀石林, 王鴻利, 主編. 血栓病學(xué). 北京: 科學(xué)出版社,1998, 53-64, 439-455. |
| 12. | Lantz M, Thysell E, Nilsson E, et al. On the binding of tumor necrosis factor( TNF) to heparin and the release in vivo of the TNFbinding protein 1 by heparin. J Clin Invest, 1991, 88: 2026-2031. |
| 13. | Dikensoy O, Zhu Z, Na MJ, et al. Intrapleural heparin or heparin combined with human recombinant DNase is not effective in the treatment of empyema in a rabbit model. Respirology, 2006, 11: 755-760. |
| 14. | Ray RL, Berkenbosh JW, Russo P, et al. Tissue plasminogen activator as a adjunctive therapy of empyema in pediatric patients. J Intensive Care Med, 2004, 19: 44-50. |
| 15. | Simpson G, Roomes D, Heron M. Effects of streptokinase and deoxyribonuclease on viscosity of human surgical and empyema pus. Chest, 2000, 117: 1728-1733. |
| 16. | Zhu Z, Hawthorne ML, Guo Y, et al. Tissue plasminogen activator combined with human recombinant DNase is effective therapy for empyema in a rabbit model. Chest, 2006, 129: 1577-1583. |
- 1. Laisaar T, Puttsepp E, Laisaar V, et al. Early administration of intrapleural streptokinase in the treatment of multiloculated pleaural effusions and pleural empyemas. Thorac Cardiovasc Surg, 1996, 44 :252-256.
- 2. 呂友堤, 陳平, 徐敏. 測(cè)定胸液中D-二聚體含量的臨床意義. 湖南醫(yī)科大學(xué)學(xué)報(bào), 2000, 25: 71-72.
- 3. Cochran JB, Tecklenburg FW, Turner RB. Intrapleural instillation of fibrinolytic agents for treatment of pleural empyema. Pediatr Crit Care Med, 2003, 4: 39-43.
- 4. Basile A, Boullosa-Seoane E, Dominguez Viguera L, et al.Intrapleural fibrinolysis in the management of empyemas and haemothoraces. Our experience. Radiol Med, 2003, 105: 12-16.
- 5. 姜軼飛, 程海英, 姚楊偉. 胸腔內(nèi)注射肝素防治包裹性胸腔積液. 臨床醫(yī)學(xué), 2007, 27: 57.
- 6. Park CS, Chung WM, Lim MK, et al. Transcatheter instillation of urokinase into loculated pleural effusion: analysis of treatment effect. Am J Roentgenol, 1996, 167: 649-652.
- 7. Kornecki A, Sivan Y. Treatment of loculated pleural effusion with intrapleural urokinase in children. J Pediatr Surg, 1997, 32: 1473 -1475.
- 8. Kwak SM, Park CS, Cho JH, et al. The effects of urokinase instillation therapy via percutaneous transthoracic catheter inloculated tuberculous pleural effusion: a randomized prospective study. Yonsei Med J, 2004, 45: 822-828.
- 9. 黃秀云. 肝素鈉胸腔內(nèi)注入治療結(jié)核性滲出性胸膜炎的臨床觀察. 臨床薈萃, 2006, 21: 1041-1042.
- 10. Strange C, Baumann MH, Sahn SA, et al. Effects of intrapleural heparin or urokinase on the extent of tetracycline-induced pleural disease. Am J Respir Crit Care Med, 1995, 151: 508-515.
- 11. 李家增, 賀石林, 王鴻利, 主編. 血栓病學(xué). 北京: 科學(xué)出版社,1998, 53-64, 439-455.
- 12. Lantz M, Thysell E, Nilsson E, et al. On the binding of tumor necrosis factor( TNF) to heparin and the release in vivo of the TNFbinding protein 1 by heparin. J Clin Invest, 1991, 88: 2026-2031.
- 13. Dikensoy O, Zhu Z, Na MJ, et al. Intrapleural heparin or heparin combined with human recombinant DNase is not effective in the treatment of empyema in a rabbit model. Respirology, 2006, 11: 755-760.
- 14. Ray RL, Berkenbosh JW, Russo P, et al. Tissue plasminogen activator as a adjunctive therapy of empyema in pediatric patients. J Intensive Care Med, 2004, 19: 44-50.
- 15. Simpson G, Roomes D, Heron M. Effects of streptokinase and deoxyribonuclease on viscosity of human surgical and empyema pus. Chest, 2000, 117: 1728-1733.
- 16. Zhu Z, Hawthorne ML, Guo Y, et al. Tissue plasminogen activator combined with human recombinant DNase is effective therapy for empyema in a rabbit model. Chest, 2006, 129: 1577-1583.