Clinical Analysis Of Malignant Pleural Effusion Treated By Thoracic Injection

Objective: Malignant pleural effusion(MPE)refers to pleural effusion which arises from primary malignant tumor of pleura or other pleural metastatic tumors,lung cancer is the most common,accounting for about 1/3 of MPE.The prognosis of MPE is very poor.From the beginning of the diagnosis,the median survival time of patients is only 3-12 months,which is often due to more fluid volume,rapid development,and easy to relapse after treatment,which seriously affects the quality of life of patients.How to treat and control malignant pleural effusion is a difficult problem in clinical work.At present,therapies for MPE including diuresis,limit salt,chest drainage,intra-pleural injections with medicine(chemotherapy drugs,biologics,and traditional Chinese medicine preparations,etc.),as well as surgical means and so on.There is no strong evidence-based medical support for intraperitoneal injection.In recent years,it has been reported that the effect of intrathoracic injection on MPE is generally better,but there is a certain difference in the actual application process.In addition,but the severe adverse effects and relevant managements are rarely reported.Further exploration and summary are necessary.Method:This paper retrospectively analyze the clinical data and clinical characteristics from April 2013 to August 2017 in our department by thel treatment of 51 patients with malignant pleural effusion,through accessing to case,telephone,outpatient service.According to different drugs in thoracic cavity in our department,it can be divided into three groups: N-CWS,elemene,lentinan.All groups were given the drug after fully chest drainage.The group of N-CWS: intrathoracic injection of N-CWS was(600-800)ug per time.The group of elemene: the dosage of intrathoracic elemene injection was calculated by 300 mg/m2,The group of lentinan: intrathoracic injection of lentinan was(1-4)mg per time.According to the WHO standard,observe the efficiency(CR+PR),observe and summarize the adverse reaction and treatment plan after treatment.Referred to WHO standard,the efficiency was calculated by(CR+PR),and the adverse reaction and treatment methods were summarized and summarized.Result:1.Case data and clinical features: most of the patients were aged over 60(84.3%),mainly between 60 and 70 years old(45.1%);Gender ratios is balanced;The primary tumor type was mainly lung cancer,with 45 cases(88.2%),of which the lung adenocarcinoma was 47.1%.17 patients(33.33)were diagnosed by bronchoscopy,18patients(35.29%)were diagnosed by cytological examination of exfoliated cells in hydrothorax,6 cases(11.76%)were diagnosed by percutaneous lung biopsy,4 cases(7.84%)were confirmed by metastatic lesions biopsy,4 cases(7.84%)were confirmed by postoperative pathology,1 case(1.96%)was were diagnosed by mediastinal biopsy,1 case(1.96%)was diagnosed by gastroscope biopsy.2.Groups and treatments: The efficiency of three groups with thoracic injection of N-CWS,elemene,lentinan were 73.3%,54.5% and 33.4%,respectively,and the difference was not statistically significant(P =0.089).Comparison between groups,The efficiency of the N-CWS group was higher than that of the lentinan group.,the difference was statistically significant(P=0.028),The efficiency of elemene group was higher than that of lentinan,there was no statistically significant difference(P =0.279).The efficiency of N-CWS group was higher than that of elemene group,and the difference was not statistically significant(P= 0.320).3.Autophagy activates activated autophagy cells,resulting in decreased proliferation and differentiation of alveolar epithelial stem cells.3.adverse reaction of intra-pleural drugs,treatment and outcome: Among the 51 patients,adverse reactions were more commonly characterized by fever,chest tightness,difficulty in breathing,chest pain,etc,for drug approaches and pharmacological difference,no more adverse reactions were compared between groups.In the elemene group,there were 7 patients with severe adverse reactions,1case showed dyspnea,cyanosis,and confusion of consciousness;Two cases showed severe chest pain;Three cases showed difficulty in breathing;One case showed coagulation dysfunction.The occurrence time was 20 min-14 h after administration.Conclusion:1.The onset age of MPE patients is mostly over 60 years old;There was no difference between males and females;The primary tumor type was mainly lung cancer,with the highest proportion of lung adenocarcinoma.Most of the patients were diagnosed by bronchoscopy and pleural effusion precipitate.The pathologic diagnosis of pleural effusion is a preferable complementary method,and it maybe the only way for some patients.2.Intrathoracic injection of N-CWS is effective in the treatment of malignant pleural effusion,with small adverse reactions,and more suitable for patients with poor general condition,with clinical application value.3.The adverse reactions in the treatment of malignant pleural effusion is characterized by fever,chest tightness,chest pain,etc,which can be alleviated through symptomatic treatment.4.Strict screening,full preprocessing and close monitoring are necessary to prevent serious adverse reactions caused by elemene injection in the treatment of malignant pleural effusion.