| Tuberculosis is the most serious infectious disease threatening human health in the world.China is the second country with relatively heavy burden of tuberculosis after India.Pleurisy caused by mycobacterium tuberculosis is a relatively common type of tuberculosis.The incidence rate has been increasing in recent years.In the 1980 s,TB pleurisy accounted for 3.2%-7.0% of TB inpatients in the same period.In the 1990 s,it has climbed to 10.9%,which is astonishing.Therefore,the timely diagnosis and treatment of tuberculous pleurisy plays an extremely important role in the whole tuberculosis management.Some studies show that some patients with tuberculous pleurisy will be accompanied by tuberculosis.However,tuberculous pleurisy is a common pulmonary tuberculosis.Its pathogenesis is the inflammatory reaction of Mycobacterium tuberculosis and its related metabolites acting on the pleura cavity in highly sensitive emotional state.At present,there are many deficiencies in the treatment of tuberculous pleurisy,some patients left pleura thickening and adhesion,some patients have more encapsulated effusion,which will have a certain impact on lung function.Many reasons have led to a large number of patients with tuberculous encapsulated pleura effusion.For patients with tuberculous pleura effusion,drainage of pleura effusion should be completed as early as possible.For patients who have already formed encapsulated pleura effusion,at present,drugs such as urokinase,heparin,hormone and other drugs can be injected into the chest cavity,as well as closed thoracic drainage,medical thoracoscopy,bronchoscopy instead of thoracoscopy and other treatments Methods: surgical intervention treatment mostly increased the economic burden of patients,and had certain trauma.In this study,based on the standard anti-tuberculous treatment scheme,the treatment of tuberculous pleura effusion with compound bromelain enteric coated tablets combined with intrathoracic catheterization and urokinase injection is simple,patient compliance is good,and the economic burden of patients can be reduced,which is worth popularizing.Objective: To explore the treatment of tuberculous pleural effusion with compound bromelain enteric coated tablets combined with drainage tube and urokinase on the basis of standard anti-tuberculous treatment,and to observe the final effect.Methods: 60 patients with tuberculous pleura effusion were selected from Taixing second hospital from January 2017 to December 2017,who were diagnosed clinically(some patients were diagnosed pathologically after pleura biopsy).They were randomly divided into control group and experimental group,with 30 patients in each group.According to the design requirements,a group of retrospective data was added.30 patients with tuberculous pleural effusion were selected from Xingtai second hospital from January 2016 to December 2016,who were diagnosed clinically(some patients were diagnosed pathologically after pleural biopsy).They were all primary patients,including 18 males and 12 females,with an average age of 30 years.There were differences in gender,age,course of disease and other basic data among the three groups,but there was no statistical significance and comparability.On the basis of conventional chemotherapy,the control group received 2-3 times of conventional thoracic puncture and fluid extraction every week,then anti tuberculosis drugs and hormone were injected into the thoracic cavity.On the basis of conventional chemotherapy,the experimental group received compound bromelain enteric coated tablets combined with central venous catheter for fluid drainage,and urokinase was injected once a week.In the retrospective group,30 patients were treated with closed thoracic drainage under B-ultrasound and urokinase once a week.To observe the improvement of clinical symptoms,the absorption time of pleural fluid,the improvement of pleural hypertrophy,the recovery of pulmonary function and the effective rate of treatment in the three groups.The mean ± standard deviation(± s)was used to express,variance analysis was carried out,and statistical comparison was carried out.Results:1.Time for symptoms to improve(1)Time required for fever to subside :4.00 ± 0.39 days in the experimental group,8.21 ± 0.42 days in the control group and 5.51 ± 0.45 days in the retrospective group,there was significant difference among the three groups(P < 0.05);(2)Time required for chest pain,chest distress and other discomfort to disappear: the experimental group was 5.04 ± 0.05 days,the control group was 13.40 ± 0.68 days,and the retrospective group was 7.34 ± 0.46 days,there was significant difference among the three groups(P < 0.05);2.The time required for pleura effusion to reduce to self absorption after treatmentThe experimental group was 5.73 ± 1.46 days,the control group was 13.73 ± 2.48 days,the difference between the two groups was statistically significant(P < 0.05).In the control group,5 cases had difficulty in aspiration,1 case had serious encapsulated pleura effusion,and 6 months later,the operation of pleura exfoliation was performed.3.Thickness of pleuraAfter intensive treatment for 2 months,the thickness of pleura was 2.51 ± 0.28 mm in the experimental group,5.60 ± 0.48 mm in the control group and 4.32 ± 0.48 mm in the retrospective group,there was significant difference among the three groups(P < 0.05);4.Recovery of pulmonary functionthe predicted percentage of VC and FEV1 / FVC in the experimental group was better than that in the control group and the retrospective group(P < 0.05);5.Treatment efficiencyThe effective rate of the experimental group and the treatment group was 100% in the experimental group,83.33% in the control group and 96.67% in the retrospective group.There was a significant difference between the three groups(P < 0.05).The experimental group and the retrospective group had a significant reduction of pleural thickening and adhesion before and after treatment,and the compressed atelectasis recovered,but the experimental group was better than the retrospective group.In the control group,the thickening and adhesion of pleura were less than before,and the recovery of compressed atelectasis was slower.The use of fibrinolytic drugs had little effect on the coagulation function of the patients in the experimental group and the retrospective group.Conclusions:1.On the basis of standard anti-tuberculosis treatment,the treatment of compound bromelain enteric coated tablets combined with thoracic catheter drainage and urokinase injection can solve the problems of partially encapsulated pleura effusion and pleura thickening and adhesion which are difficult to be solved by traditional methods to a certain extent;2.The traditional methods were inferior to the experimental group in the improvement of clinical symptoms,the absorption time of pleura fluid,the degree of pleura hypertrophy,the recovery of pulmonary function,the effective rate of treatment and the rate of pleura exfoliation;3.The treatment of tuberculous pleura effusion with compound bromelain enteric coated tablets combined with thoracic catheter drainage and urokinase injection can shorten the treatment cycle,reduce the incidence of pleura exfoliation,better recover the pulmonary function of patients,and improve the prognosis of patients with tuberculous pleura effusion.In conclusion,the treatment of tuberculous pleura effusion with compound bromelain enteric coated tablets combined with thoracic cauterization and urokinase injection has good efficacy and compliance,and does not increase the economic burden of patients. |
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