【作者】 李多含；

【导师】 齐协飞；

【作者基本信息】 南昌大学 ， 内科学， 2006， 硕士

【摘要】 目的 观察滑石粉联合顺铂胸腔内灌注治疗恶性胸腔积液的疗效及毒副反应。 方法 将33例恶性胸腔积液患者随机分为2组，滑石粉联合顺铂治疗组(治疗组)15例，顺铂治疗组(对照组)18例，所有患者均采用中心静脉导管进行胸腔闭式引流，待胸腔积液引流彻底后给予胸腔内给药，滑石粉联合顺铂治疗组：给予生理盐水30ml+滑石粉3～4g，半小时后再给予生理盐水30ml+顺铂60mg。顺铂治疗组：给予生理盐水30ml+顺铂60mg。注药后夹管并嘱患者变换体位，6小时后重新放开引流，待引流液体量每日少于50～100ml则考虑拔管。随后，每2周复查胸片或B超，2个月后观察比较两组胸腔积液量的变化、呼吸困难等症状改善、Karnofsky(KPS)标准评分变化和毒副反应。 结果 2月后结果显示：滑石粉联合顺铂组：完全缓解(CR)10例，部分缓解(PR)4例，无效(NR)1例，总有效率(CR+PR)93.3％；顺铂组：CR 2例，PR 9例，NR 7例，总有效率(CR+PR)61.1％，滑石粉联合顺铂组优于顺铂组，两组疗效比较有显著差异(P＜0.05)。患者呼吸困难等症状明显改善。治疗组KPS评分由60.00±5.35提高到76.00±5.07，对照组KPS评分由61.67±5.15提高到65.56±7.84，两组比较有显著性差异(P＜0.05)。主要毒副反应为胸痛、发热、恶心、呕吐等，治疗组比对照组胸痛、发热发生率更高(P＜0.05)，所有患者均未发生严重的并发症。 结论 滑石粉联合顺铂治疗恶性胸腔积液是一种安全有效的治疗手段，能有效控制胸腔积液，缓解呼吸困难等症状，改善体力状况，提高生活质量，无明显毒副作用。更多还原

【Abstract】 Objective: To observe the efficacy and toxicity of the talc combined with DDP in the treatment of malignant pleural effusion(MPE).Methods: 33 cases of pleural effusion were divided randomly.into two groups , the talc combined with DDP group( treament group) and DDP group( control group).There were 15 patients in the talc combined with DDP group,the other were 18 patients in DDP group. A chest drain(central venous catheter) was inserted in all patients.The adminisatration was performed when the chest cavity was drained as completely as possible. The talc combined with DDP group: 3 to 4 grams of asbestos-free talc were suspended 30ml of saline solution(0.9%) injected via the chest tube drain into the pleural space, after an addition 30 minutes,DDP60mg mixed with 30ml of saline solution(0.9%) were injected though the chest tube too.DDP group: DDP60mg mixed with 30ml of saline solution(0.9%)were injected via the chest tube drain into the pleural space .All patients were asked to change their position every 5 to 10 minutes to allow adequate distribution .The drains was then clamped , the chest tube was then unclamped after 6 hours, the chest cavity was drained again.The 24-hours output from the chest tube is less than 50 to 100ml, the intercostals drain was removed.In the two months after trentment, chest radiograph or B-ultrasomotonography were used to evaluated the conditions of the patients every 2 weeks. The comparison was made on MPE and dyspnea between two groups, changes of Karnofsky performance status score and toxicity before and after each of these two treatments.Results:when the patients have been treated for two months, chest radiograph or B-ultrasomotonography were repeated in them.The results showed:the talc Combin更多还原