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目的比较中心静脉导管双侧引流与传统胸腔闭式引流治疗恶性胸腔积液的临床效果,并分析其护理要点。方法选取保定市第一中心医院2014年6月—2016年6月收治的恶性胸腔积液患者87例,按照随机数字表法将患者分为对照组42例与观察组45例。对照组患者给予传统胸腔闭式引流治疗,观察组患者给予中心静脉导管双侧引流治疗,两组患者均予以胸腔注射化疗药物,治疗1个月后比较两组患者呼吸困难消失时间及引流时间、一次性置管成功率、切口愈合时间、镇痛药使用率、治疗疗效、化疗药物毒副作用和置管并发症。结果观察组患者呼吸困难消失时间、引流时间、切口愈合时间短于对照组,镇痛药使用率低于对照组(P<0.05);两组患者一次性置管成功率比较,差异无统计学意义(P>0.05)。治疗后两组患者胸腔积液治疗效果比较,差异无统计学意义(P>0.05)。两组患者化疗毒副作用发生情况比较,差异无统计学意义(P>0.05)。对照组患者并发复张性肺水肿3例,严重胸膜反应2例,观察组无一例发生严重并发症。结论传统胸腔闭式引流与中心静脉导管双侧引流治疗胸腔积液的临床效果相当,但中心静脉导管双侧引流患者的引流时间、呼吸困难消失时间短,只要护理妥当,可减少堵管及移位发生,且无严重并发症,并不会增加化疗药物的毒副作用。
Objective To compare the clinical effects of bilateral venous drainage of central venous catheter with traditional closed thoracic drainage in the treatment of malignant pleural effusion and to analyze the nursing points. Methods 87 patients with malignant pleural effusion admitted to the First Central Hospital of Baoding from June 2014 to June 2016 were selected and divided into control group (n = 42) and observation group (n = 45) according to random number table method. Patients in the control group were given conventional closed thoracic drainage. Patients in the observation group were treated with bilateral drainage of central venous catheters. Both groups were given intrathoracic chemotherapy. After 1 month of treatment, the disappearance of dyspnea and drainage time were compared between the two groups. Success rate of one-time catheterization, incision healing time, analgesic use rate, curative effect, side effects of chemotherapy drugs and catheter complications. Results The disappearance time, drainage time and incision healing time of observation group were shorter than that of control group, and analgesic use rate was lower than that of control group (P <0.05). There was no significant difference in the success rate of one-time catheterization between two groups Significance (P> 0.05). After treatment, the two groups of patients with pleural effusion treatment effect, the difference was not statistically significant (P> 0.05). There was no significant difference between the two groups in the incidence of chemotherapy side effects (P> 0.05). In the control group, there were 3 cases of recurrent pulmonary edema and 2 cases of severe pleural reaction. None of the cases in the observation group had serious complications. Conclusions The clinical effect of conventional closed thoracic drainage and central venous catheter double drainage for the treatment of pleural effusion is similar. However, the drainage time and shortness of breathlessness of patients with bilateral venous drainage in central venous catheters are short, and as long as the nursing is proper, the occlusion and displacement can be reduced Bit occurred, and no serious complications, does not increase the side effects of chemotherapy drugs.