胸腔內注入肝素或尿激酶治療結核性胸膜炎的臨床對比研究_《中國呼吸與危重監護雜志》

作者：

黃炎明 ¹ , 謝燦茂 ² , 左萬里 ¹

1 江門市中心醫院呼吸內科（廣東江門 529070）;;
2 中山大學附屬第一醫院呼吸內科（廣東廣州 510080）;

關鍵詞：

肝素尿激酶纖維蛋白原 D-二聚體結核性胸膜炎胸腔積液

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目的比較胸腔內注入肝素、尿激酶或生理鹽水對預防和治療結核性胸膜炎引起胸膜增厚和粘連的效果。方法 60 例結核性胸膜炎患者隨機分為3 組, 每組20 例, 分別于胸腔內注入肝素( 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間, 治療2 個月后胸膜厚度和胸膜粘連的發生率。結果肝素組注射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] , 胸膜粘連發生率亦明顯低于對照組( 15%、20% 比50% , P lt;0. 05) 。結論胸腔內注入肝素預防和治療結核性胸膜炎的胸膜增厚和粘連的療效與尿激酶相似, 明顯優于生理鹽水。由于肝素價廉、藥源充足和安全性好, 可作為預防和治療結核性胸腔積液并發癥的一線藥物。

引用本文： 黃炎明,謝燦茂,左萬里. 胸腔內注入肝素或尿激酶治療結核性胸膜炎的臨床對比研究. 中國呼吸與危重監護雜志, 2009, 09(3): 247-250. doi: 復制

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. 湖南醫科大學學報, 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. 胸腔內注射肝素防治包裹性胸腔積液. 臨床醫學, 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. 肝素鈉胸腔內注入治療結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. 北京: 科學出版社,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. 測定胸液中D-二聚體含量的臨床意義. 湖南醫科大學學報, 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. 胸腔內注射肝素防治包裹性胸腔積液. 臨床醫學, 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. 肝素鈉胸腔內注入治療結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. 北京: 科學出版社,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.

《中國呼吸與危重監護雜志》

胸腔內注入肝素或尿激酶治療結核性胸膜炎的臨床對比研究

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《中國呼吸與危重監護雜志》

胸腔內注入肝素或尿激酶治療結核性胸膜炎的臨床對比研究

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