胸腔置管注入尿激酶治疗结核性胸腔积液护理管理

目的探讨胸腔置入中心静脉导管(以下简称导管)治疗结核性胸腔积液(以下简称胸水)的护理管理。方法将260例患者(无包裹性)按数字随机法分为治疗组和对照组,治疗组采用胸腔置管并注入尿激酶;对照组给予常规间断抽取胸水,比较两组穿刺点感染、穿刺点疼痛、胸膜反应、气胸、复张性肺水肿、胸水排出量、住院费用等情况。结果治疗组和对照组有穿刺点感染者分别为3和10例,有穿刺点疼痛者分别为5和30例;有胸膜反应者分别为3和10例,两组差异均有统计学意义(P0.05或P0.01)。复张性肺水肿、气胸,两组差异无统计学意义(P0.05)。治疗组胸水排出量多(3 891±571)ml vs(2 874±493)ml],住院费用低(1 417.9±341.8)元vs(2 390.9±606.8)元],但两组差异有统计学意义(P0.01)。结论胸腔内置入导管并注入尿激酶治疗结核性胸水,减轻了患者反复穿刺的痛苦,但须加强置管后的皮肤和导管护理。

Nursing management of injection of urokinase through chest tube in treatment of tuberculous pleural effusion

Objective]To discuss the nursing management of indwelling central venous catheter in treatment of tuberculous pleural effusion.Methods]260 patients（no encapsulated effusion） were randomly divided into the treatment group and the control group.The treatment group was given chest tube and injection of urokinase.The control group was treated by routine extracting hydrothorax.The infection and pain of puncture point,pleural reaction,aerothorax,reexpansion pulmonary edema,volume of pleural effusion and hospitalization expenses between two groups were compared.Results]There were 3 cases and 10 cases of puncture point infection in the treatment group and the control group respectively,5 cases and 30 10 cases of puncture point pain in two groups respectively,3 cases and 10 cases of pleural reaction in two groups respectively,and the differences were significant（P0.05 or P0.01）.There was no significant difference in the incidence rates of reexpansion pulmonary edema and aerothorax（P0.05）.The volume of pleural effusion in the treatment group （3 891±571） ml]was higher than that in the control group （2 874±493）ml],the hospitalization expenses of the treatment group（1 417.9±341.8） YUAN]was lower than that of the control group （2 390.9±606.8） YUAN],and the differences between two groups were significant（P0.01）.Conclusion]Indwelling central venous catheter and injection of urokinase in treatment of tuberculous pleural effusion can alleviate patients＇ pain caused by repeated puncture,but the nursing in skin and catheter after intubation should be improved.