静脉导管穿刺治疗老年肺脓肿的研究.doc

静脉导管穿刺治疗老年肺脓肿的研究 作者：李勇1a,朱为夷1a,周代君1b 作者单位：1.第三军医大学学员旅：a.二队;b.四队;c.八队，重庆 400038;2. 南方医科大学附属柳州医院内科，广西 柳州 【摘要】目的观察双腔中心静脉导管经皮穿刺对老年肺脓肿的治疗效果。 方法 将40例老年肺脓肿患者随机分成常规内镜组和导管组，每组20例。导管组(实验组)在常规治疗的基础上，用双腔中心静脉导管经皮穿刺进入肺脓腔处，并使用生理氯化钠溶液以及尿激酶和抗生素稀释液反复抽洗脓腔，直到脓液相对极少而且清亮，脓腔闭合时，拔出引流管;内镜组(对照组)常规治疗基础上，用纤维支气管镜吸引并冲洗和局部注射给药。 结果 导管组和内镜组2周治愈率分别为55%和15%，出院治愈率为95%和50%，差异有统计学意义(P 0.05)。且导管组平均住院日及发热日数均较内镜组减少(P 0.05)。 结论 双腔中心静脉导管经皮穿刺留置抽洗治疗老年肺脓肿较常规治疗更安全、有效。 【关键词】 老年肺脓肿;双腔静脉导管;穿刺;CT定位 Abstract： Objective To observe the therapeutic effects of double cavity central venous catheters on pulmonary abscess through percutaneous puncture. Methods Totally 40 elderly patients with pulmonary abscess were divided into two groups (n=20): experimental group and control group. In experimental group, double cavity central venous catheters were inserted into the pus cavity through percutaneous puncture and physiological saline, urokinase as well as antibiotic diluent were applied to wash the pus cavity repeatedly. The catheters were pulled out until the sanies became few and clear and the pus cavity closed. In control group, textile fiber bronchoscope was employed to attract and flush the pus cavity based on the conventional treatment. Results The curative rates within 15 days were 55% and 15% in experimental and control group respectively and those after discharge were 95% and 50 % (P 0.05). The average duration and days having fever were fewer in experimental group than in control group (P 0.05).Conclusion It is safe and effective to treat pulmonary abscess with double cavity central venous catheters Keywords: pulmonary abscess; double cavity central venous catheters; puncture; CT positioning 老年人由于心肺等脏器功能减退、基础疾病增多、免疫功能逐渐低下，患上肺脓肿的概率逐年呈上升趋势。肺脓肿常规采用全身应用体位引流、抗生素及纤维支气管镜灌洗等药物和手术结合的方法治疗，但常因全身应用抗生素的抗菌效果不理想、体位引流不能够彻底将脓液引流、反复镜下吸痰病人难以忍受等受限导致其疗效较差[1]。本文就40例老年肺脓肿患者采用CT预定位而后运用x线片引导下双腔中心静脉导管经皮穿刺抽洗创伤面而后注药治疗肺脓肿，有效地解决体位引流治疗不理想、反复内镜操作及手术带来的不良影响等问题，通过和常规治疗方法的比较研究，为临床提供选择参考。 1 资料与方法 1.1 临床资料 选取2009年9月至2010年2月本院治疗的40例老年(年龄65岁以