Application Of Intrapleural Urokinase And Thoracoscopy In The Treatment Of Tuberculous Pleurisy

Objective:(1) Discuss the prevention and treatment role of intrapleural urokinase in early tuberculous pleurisy (duration≤6 weeks) caused pleural thickening and adhesion; (2) Discuss the mechanism of intrapleural urokinase therapy in tuberculous pleurisy; (3) Discuss the adverse reactions and side effects of intrapleural urokinase. (4)Discuss the efficacy and complications under local anesthesia-assisted thoracoscopic treatment of tuberculous encapsulated pleurisy; (5) to investigate the efficacy of the treatment of intrapleural urokinase for tuberculous encapsulated pleurisyMethod:(1) Select 60 patients whose course of tuberculous pleurisy≤6 weeks and without pleural package, extensive hypertrophy, adhesion, randomly divided into urokinase group and control group. All underwent chest central venous catheter implantation, after extracting 600ml at the first time, the UK group were injected urokinase 250000 IU which was soluted with 50ml sodium chloride through intrapleural catheter; the control group were injected 50ml sodium chloride through catheter, other treatments were same. Observing the improvement of the clinical symptoms after 72 hours (chest pain, shortness of breath, fever, etc.); and fibrinogen, thrombin time, prothrombin time, D-dimer of the pleural effusion; the time of complete drainage of pleural effusion and the total amount drainage of pleural effusion; the difference of pleural adhesion level and pleural thickness before and after the treatment; the difference of lung function before and after treatment; the adverse reactions of intrapleural urokinase. (2)Select 61 patients>6 weeks and showed pleural package, hypertrophy, adhesion of tuberculous encapsulated pleurisy and randomly divided into thoracoscopic group and control group. Thoracoscopic group received thoracoscope treatment under local anesthesia, the control group were given repeated thoracentesis and intrapleural 100000 IU urokinase dissolved with 20ml Sodium Chloride, usually 1 to 3 times, other treatments were same. To observe clinical symptoms improved after treatment; pleural effusion disappeared and separate parcels, adhesion; parietal pleural thickness; changes in lung function; complications or adverse reactions. Results:(1)Intrapleural urokinase 72 hours later,there was significant difference in the improvement of shortness of the UK group and the control group (P<0.05), and there was no significant difference in the change of chest pain and fever and so on (all P>0.05); the fibrinogen concentration in pleural effusion was significantly decreased than in the control group and before treatment (P<0.01); thrombin time and prothrombin time of pleural effusion were significantly longer than which before the treatment and control group (all P<0.01); D-dimer levels in the pleural effusion was significantly increased than the control group and before treatment (P<0.01); there was no significant difference in the time of complete drainage of pleural effusion between 2 groups (P>0.05), compared with the control group, the total amount of pleural effusion of urokinase group were significantly increase (P<0.01); parietal pleura of the UK group after 2 months'treatment was significantly thinner (P<0.01), while the control group were significantly thicken (P<0.01), after treatment the pleural adhesion of urokinase group was lesser extent (P<0.05); after drainage pleural effusion, pulmonary function was improved, particularly after the injection of urokinase, compared with the control group FVC% and ERV% were significantly increased, FEV1/FVC% was significantly lower (P<0.01); after intrapleural urokinase, there were no significantly difference of platelets, fibrinogen, prothrombin time, thrombin time compared with the control group (P>0.05); All UK group Intrapleural injection of urokinase in patients tolerated the treatment, during and after the treatment showed no fever, itching, rash and other allergic reactions, no subcutaneous bleeding, gingival bleeding or hematuria occurs. (2)2 weeks after treatment, fever, shortness of breath, chest pain and other symptoms of thoracoscopic group were improved better than in the control group (P<0.01 or P<0.05); treatment 2 months later,the rate of disappearance of pleural effusion in thoracoscopy group was higher, while pleural adhesions, parcels were lower than control groups (P<0.01); 2 months after treatment, parietal pleural thickness of thoracoscopy group was significantly thinner than before treatment and the control group (all P<0.01),2 months after treatment the thickness of parietal pleural of control group thickening than before treatment (P<0.01); 2 months after treatment FVC%, ERV% of thoracoscopic group were higher, while the FEV1/FVC% lower than the control group (P<0.01); thoracoscopic group had no bleeding and air embolism, reexpansion pulmonary edema, pulmonary atelectasis, chest infections and other serious complications.Conclusion:(1)intrapleural urokinase treatment of early non-encapsulated tuberculous pleural effusion (duration≤6 weeks), could increase the volume of pleural effusion, pleura thinning, lower the incidence of pleural adhesions, improve the restrictive pulmonary function disorder; (2) after intrapleural urokinase, because of the enhancement of fibrinolytic activity of pleural effusion, fibrinogen and fibrin degradatiohn, reduce the degree of pleural adhesions; (3) no effect of blood coagulation and fibrinolysis system, and no increase in chest pain,fever and other adverse reactions of intrapleural urokinase, patients were well tolerated; (4) Intrapleural urokinase in the treatment of early non-encapsulated tuberculous pleural effusion (duration≤6 weeks) is a safe, highly effective method, is worthy of promotion; (5) under local anesthesia-assisted thoracoscopic treatment of tuberculous encapsulated pleurisy, the clinical symptoms obviously improved, increased disappearance rate of pleural fluid, reduction package rates of pleural adhesion and to make thinner parietal pleura, improve the restrictive pulmonary function disorder; (6) thoracoscopy under local anesthesia to treat tuberculous encapsulated pleurisy is safe, simple, little damage, good efficacy, low complication rate, and can also obtain pathological diagnosis, is worthy of promotion; (7) intrapleural urokinase in the treatment of tuberculous encapsulated pleurisy had poor efficacy.