| OBJECTIVE:To investigate the mechanism,adverse reactions and side effects of intrathoracic injection of urokinase in the treatment of tuberculous pleurisy,and to summarize and analyze the curative effect and clinical application value of intrathoracic injection of different doses of urokinase in the treatment of tuberculous pleurisy,and to further improve the understanding and treatment experience of the disease.METHODS:To retrospectively analyze of tuberculous pleurisy cases from December 2013 to December 2019 in the Department of Respiratory and Critical Care Medicine of the second Hospital of Jilin University,and after admission with thoracic puncture and indwelling thoracic drainage tube.The collected contents included age,sex,clinical manifestation,imaging examination,laboratory examination,treatment plan,curative effect,adverse reaction and so on.The data were treated by SPSS 24.0,and the p value was less than 0.05 considered the difference to be statistically significant.RESULTS:1.A total of 90 patients were included in this study,with an average age of about 41.60±18.45 years,80%(72/90)under 60 years of age and 20.00%(18/90)over60 years of age,of which 48.89%(44/90)were aged 15-39 years.The majority of the sick age is young and middle-aged population,the age has a tendency to delay.There were 59 males and 31 females in the study,and the ratio of males to females was about 1.90:1.2.The number of cases of symptom improvement in each group in the study was tested,and the p value were more than 0.05.There was no significant difference.The symptoms of the selected cases were obviously improved after thoracic puncture and drainage and thoracic lavage.Bilateral pleural effusion accounted for17.78%(16/90)and unilateral pleural effusion accounted for 82.22%(74/90).The main lesion was unilateral.The hospitalization time and sufficient drainage time of pleural effusion cases were tested by single factor chi-square test,and the difference among with the groups were not statistically significant,which indicated that the use of urokinase or not had no obvious effect on the course of disease.The p value of drainage of pleural fluid were less than 0.01.Through multiple comparison,The p value were less than 0.05 about group B and C compared separately with the group A,indicating that the drainage of pleural fluid was significantly higher in group B and group C than in group A,and C group was more significant than B group.It is proved that urokinase irrigation can increase the drainage of pleural fluid and make it fully draining.3.The pleural effusion in the study was similar in nature,routine and biochemical accord with exudative pleural effusion properties.After single factor ANOVA test,there was no statistical difference between groups.The mean value of ESR was 47.56±22.04 mm/h,63 patients(88.73%)and the C reactive protein(CRP)test was completed in 66 patients,with an average value of 39.00±23.38 patients(95.45%).These two indexes have increased in tuberculous pleurisy,have suggestive significance.After one day of chest injection,compared with blood coagulation routine and blood routine in each group,including TT、APTT、PT、fibrinogen,blood routine,platelets and other indicators,the p values of each index group compared were greater than 0.05,indicating that the difference is not statistically significant.4.The pleural thickness of each group was similar during the treatment period,the median(P25-P75)was 2.66(1.95-3.17)millimeter.And the p value among with groups was more than 0.05,so there was no obvious difference or significance between groups.while after 2 months of treatment,the median pleural thickness(P25-P75)was 2.18(1.83–2.70)millimeter,and the p between groups was less than0.01.The difference was statistically significant.Multiple tests continued to be performed,indicating that the pleural thinning was obvious in group B and C compared with the group A,but there was no significant difference between group B and C.During the treatment period to 2 months after review,the cases of group A of adhesions ranged from 10%(3/30)to 40%(12/30),from 40%(12/30)to 16.67%(5/30)in group B and from 40%(12/30)to 0.67%(2/30)in group C.The results showed that Urokinase irrigation could dissolve fibrin and fibrinogen,reduce pleural adhesion wrapping,thin or reduce pleural thickness,and urokinase irrigation had no obvious allergic reaction.CONCLUSION:1.Tuberculous pleurisy mostly occurs in young and middle-aged population,but the age has the tendency of backward delay.2.The use of urokinase to flush the chest cavity,the blood coagulation system,fibrinolysis system had no obvious effect,no obvious chest pain,fever and other adverse reactions,the patient was well tolerated.3.The use of urokinase to flush the pleural cavity,it can obviously increase the drainage volume of pleural effusion,enhance the fibrin solubility of the pleural cavity,make the pleura thin and reduce the rate of pleural adhesion.4.Large dose urokinase was used to flush the pleural cavity,the drainage of pleural effusion was more significant than that of small dose.But there was no significant difference in pleural thickness after different doses urokinase treatment. |
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