• 1 江門市中心醫(yī)院呼吸內(nèi)科(廣東江門 529070);;
  • 2 中山大學(xué)附屬第一醫(yī)院呼吸內(nèi)科(廣東廣州 510080);

目的  比較胸腔內(nèi)注入肝素、尿激酶或生理鹽水對預(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( 對照組) 。治療前后分別測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比研究. 中國呼吸與危重監(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. 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. 2. 呂友堤, 陳平, 徐敏. 測定胸液中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. 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. 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. 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. 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. 7. Kornecki A, Sivan Y. Treatment of loculated pleural effusion with intrapleural urokinase in children. J Pediatr Surg, 1997, 32: 1473 -1475.
  8. 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. 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. 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. 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. 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. 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. 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. 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. 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.
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