Clinical Efficacy of Intrapleural Injection of Thrombin Combined with Drainage tube Suspension in the Treatment of Refractory Pneumothorax
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摘要:
目的 观察胸腔内注射凝血酶联合引流管悬吊治疗难治性气胸的临床疗效。 方法 纳入2020年1月至2022年2月期间邯郸市第一医院接受持续胸腔闭式引流，辅助以用持续负压吸引的常规内科治疗的52例难治性气胸患者资料，作为对照组；纳入同期医院接受胸腔内注射凝血酶联合引流管悬吊治疗的60例难治性气胸患者资料，作为观察组。治疗3周后比较2组临床疗效、临床指标（炎症发生率、肺部感染情况、肺功能障碍发生情况、刺激性咳嗽）、免疫功能指标（成熟T淋巴细胞（CD3+）、指诱导性T细胞/辅助性T细胞（CD4+）、抑制性T细胞/细胞毒性T细胞（CD8+））以及药物不良反应情况。 结果 治疗3周后，观察组和对照组有效率分别为96.67%（58/60）和82.69%（43/52）（P<0.05）。治疗3周后，观察组临床指标（炎症发生率、肺部感染情况、肺功能障碍发生情况、刺激性咳嗽）优于对照组，差异具有统计学意义（P<0.05）。治疗3周后，2组免疫功能指标（成熟T淋巴细胞（CD3+）、指诱导性T细胞/辅助性T细胞（CD4+）、抑制性T细胞/细胞毒性T细胞（CD8+））均升高，且观察组高于对照组，差异具有统计学意义（P<0.05）。对照组和观察组治疗期间均无不良反应，差异无统计学意义（P > 0.05）。 结论 胸腔内注射凝血酶联合引流管悬吊治疗难治性气胸有良好的临床疗效，且治愈率较高。 Abstract:Objective To observe the clinical effect of intrathoracic thrombin injection combined with drainage tube suspension in the treatment of refractory pneumothorax. Methods Data of 52 patients with refractory pneumothorax who received continuous closed thoracic drainage in the hospital and were assisted by conventional medical treatment with continuous negative pressure suction from January 2020 to February 2022 were included as the control group. The data of 60 patients with refractory pneumothorax who received intrathoracic thrombin injection combined with drainage tube suspension treatment in the same period were included as the observation group. After 3 weeks of treatment, the clinical efficacy, clinical indicators （incidence of inflammation, pulmonary infection, pulmonary dysfunction and irritating cough）, immune function indicators [mature T lymphocytes （CD3+）, induced T cells/helper T cells （CD4+）, inhibitory T cells/cytotoxic T cells （CD8+）] and the occurrence of adverse drug reactions were compared between the two groups. Results After 3 weeks of treatment, the effective rates of the observation group and the control group were 96.67% （58/60） and 82.69% （43/52） respectively （P < 0.05）. After 3 weeks of treatment, the clinical indicators （incidence of inflammation, pulmonary infection, pulmonary dysfunction and irritating cough） in the observation group were better than those in the control group, with statistical significance （P < 0.05）. After 3 weeks of treatment, the immune function indexes （mature T lymphocytes （CD3+）, induced T cells/helper T cells （CD4+） and inhibited T cells/cytotoxic T cells （CD8+）） in both groups increased, and the difference was statistically significant （P < 0.05）. There were no adverse reactions in the control group and the observation group during treatment, and the difference was not statistically significant （P > 0.05）. Conclusion Intrathoracic thrombin injection combined with drainage tube suspension has a good clinical effect and a high cure rate in the treatment of refractory pneumothorax. -
Key words:
- Thrombin /
- Drainage tube suspension /
- Refractory pneumothorax /
- Clinical efficacy
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表 1 基线资料对比[$ \bar x \pm s $，n（%）]
Table 1. Comparison of baseline data[$ \bar x \pm s $，n（%）]
因素 对照组（n=52） 观察组（n=60） χ2/t P 性别 男 30（57.69） 33（55.00） 0.081 0.775 女 22（42.31） 27（45.00） 年龄（岁） 60.12±6.36 61.21±6.47 0.113 0.910 体重（kg） 68.13±8.99 69.36±9.08 0.718 0.474 复发情况 初次发作 26（50.00） 31（51.67） 0.811 0.667 二次复发 14（26.92） 19（31.67） 多次复发 12（23.08） 10（16.67） 胸闷 有 40（76.92） 51（85.00） 1.193 0.275 无 12（23.08） 9（15.00） 呼吸困难 有 37（71.15） 46（76.67） 0.441 0.507 无 15（28.85） 14（23.33） 刺激性咳嗽 有 39（75.00） 41（68.33） 0.607 0.436 无 13（25.00） 19（31.67） 合并基础疾病 高血压 21（40.38） 25（41.67） 0.019 0.891 高血糖 31（59.62） 35（58.33） 婚姻状况 已婚 40（76.92） 47（78.33） 0.032 0.858 单身 12（23.08） 13（21.67） 收入状况（元） ≥6000 19（36.54） 21（35.00） 0.029 0.866 <6000 33（63.46） 39（65.00） 居住环境 农村 23（44.23） 26（43.33） 0.009 0.924 城市 29（55.77） 34（56.67） 主要照顾者 家属 37（71.15） 41（68.33） 0.105 0.746 其他 15（28.85） 19（31.67） 
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表 2 临床疗效对比[n（%）]
Table 2. Comparison of clinical efficacy[n（%）]
组别 显效 有效 无效 有效率 对照组（n=52） 37（71.12） 6（11.54） 9（17.31） 43（82.69） 观察组（n=60） 54（90.00） 4（6.67） 2（3.33） 58（96.67） Z/χ2 2.627 6.142 P 0.009* 0.013* 与治疗前比较，*P<0.05。
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表 3 2组临床指标对比[n（%）]
Table 3. Comparison of clinical indexes between the two groups[n（%）]
时间 组别 炎症 肺部感染 肺功能障碍 刺激性咳嗽 治疗前 对照组 36（69.23） 25（48.08） 14（26.92） 27（51.92） 观察组 43（71.67） 29（48.33） 18（30.00） 31（51.67） χ2 0.080 0.001 0.129 0.001 P 0.778 0.979 0.719 0.979 治疗后 对照组 15（28.85） 11（21.15） 10（19.23） 13（25.00） 观察组 7（11.67） 4（6.67） 3（5.00） 5（8.33） χ2 5.209 5.041 5.499 5.737 P 0.023* 0.025* 0.019* 0.017* 与治疗前比较，*P<0.05。
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表 4 2组免疫功能指标对比（$\bar x \pm s$）
Table 4. Comparison of immune function indexes between the two groups（$ \bar x \pm s $）
时间 组别 CD3+（μL） CD4+（μL） CD8+（μL） 治疗前 对照组 70.56±7.69 50.49±5.67 36.47±4.03 观察组 71.22±7.98 49.87±5.31 35.61±3.94 t 0.444 0.597 1.140 P 0.658 0.552 0.257 治疗后 对照组 860.11±93.64a 478.17±50.74a 330.42±30.86a 观察组 1890.39±172.45a 900.63±94.13a 800.41±84.35a t 37.917 28.916 38.016 P <0.001* <0.001* <0.001* 与治疗前相同指标比较，aP<0.05；*P<0.05。
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