中心静脉导管留置加尿激酶治疗包裹性脓胸.doc

中心静脉导管留置加尿激酶治疗包裹性脓胸作者简介:张堰冬(1975-),男,四川都江堰人,主治医师,本科。? 【摘要】目的:观察超声引导下穿刺中心静脉导管留置联合尿激酶治疗包裹性脓胸的新方法并总结其疗效。方法:利用中心静脉套管针,在超声引导下对50例包裹性脓胸患者进行了穿刺排脓治疗。结果:50例患者中,经反复融解抽吸后50例患者均痊愈。平均抽液量为(650±216.8)ml。未再发现胸液增加者50例,占100%。结论:该方法是一种安全有效的包裹性脓性胸腔积液的穿刺排脓方法。? 【关键词】脓胸;治疗;中心静脉导管;尿激酶? doi:10.3969/j.issn.1006-1959.2010.08.018文章编号:1006-1959(2010)-08-1996-02? Treatment of encapsulated purulent pleural effusion by using central venous catheter and urokinase injectionZHANG Yan-dong,ZHANG Hua,YUAN Kai Department of cardiothoracic surgery,the First People’s Hospital of Liangshan,Sichuan 615000,China? 【Abstract】Objective:To observe the curative effect of treatment of encapsulated purulent pleural effusion by using central venous catheter with ultrasonic guidance and intracvitary urokinase.Methods:Fifty patients with encapsulated empyema were treated with ultrasoundguided drainage by the deep intravenous cannula needle.Results:Fifty patients were cured.The average aspiration volume of pleural fluid is(650±216.8)ml.All fifty cases didn’t find pleural fluid increasing again.Conclusion:Using deep intravenous catheter with ultrasonic guidance and adjunctive intracavitary urokinase therapy is a safe and effective method in draining the encapsulated purulent pleural effusion.? 【Key words】Purulent pleural effusion;Treatment;Central venous catheter;Urokinase injection 脓性胸腔积液简称脓胸,排脓并关闭脓腔为脓胸治疗原则之一。我们应用中心静脉导管留置脓腔内并加用尿激酶治疗包裹性脓胸取得良好疗效,避免了手术治疗,减轻了病人痛苦,尤其适合于年老体弱和或有手术禁忌的患者,现报告如下:? 1.资料与方法? 1.1一般资料:急性单纯包裹性脓胸32例,胸部术后包裹性脓胸8例,肺脓肿所致包裹性脓胸10例。男35例,女15例,年龄8~72岁,平均(46.3±15.3)岁。50例患者中,合并脓气胸9例,38例为内科和儿科治疗效果不佳转入外科治疗。在常规抗感染等治疗的基础上,行中心静脉导管套管针穿刺抽脓并行脓腔冲洗、引流。? 1.2方法:所有患者均经过临床症状、体征及X片、CT、B超等检查确诊,了解胸壁厚度和包裹性积脓范围。B超定位选择较大且大致位于包裹性积脓范围的中心部位的包裹腔所在肋间隙为穿刺点。常规消毒,铺巾,局麻生效后,在B超定位穿刺点穿刺,有脓性液抽出且抽液无阻力,证明穿刺部位正确后,放入中心静脉导管导丝,用扩张管扩张后放入中心静脉导管至合适的深度,保证抽液无阻力。成功抽出脓液后用甲硝唑溶液或生理盐水加庆大霉素8万单位的液体反复冲洗,直至冲洗液清亮后,留置生理盐水40毫升加尿激酶10～30万单位,2～4小时后再抽出腔内液体,每日一次,反复冲洗、抽吸,直至无脓性液体抽出,X片证实脓腔明显缩小或消失。? 2.结果? 50例包裹性脓胸患者中,均首次穿刺置管成功,无1例发生医源性气