【摘要】：目的：經(jīng)胸腔內(nèi)注射白介素-2(IL-2)和博來霉素（BLM）注射液局部治療惡性胸腔積液患者，觀察抽盡胸水后，胸腔注藥治療前后肺功能、動脈血氣變化，探討兩藥對患者肺功能的影響，提供臨床安全用藥參考。方法：選擇確診的中大量惡性胸水患者60例，采用胸腔管置管引盡胸水，將患者分為兩組，IL-2單藥組（A組）和BLM單藥組（B組），經(jīng)導管注入胸腔，比較治療前后肺功能、動脈血氣變化。結(jié)果：A組經(jīng)治療后對比肺活量(VC)、最大通氣量(MVV)、1秒鐘用力呼氣容積(FEV1)較用藥前有增加，增加幅度為13.76%、8.63%、10.37%，均值均有統(tǒng)計學意義(P0.05)。FVC降低，下降幅度為4.66%，均值無具統(tǒng)計學意義(P0.05)。1秒鐘用力呼氣容積占用力肺活量百分比(FEV1／FVC)降低幅度為15.59%，均值有統(tǒng)計學意義(P0.05)。最大呼氣流速(PEF)指標增長幅度為0.52%，均值無統(tǒng)計學意義(P0.05)。動脈血氧分壓（PaO2）升高幅度為4.89%，均值有統(tǒng)計學意義(P0.05)。B組治療后VC、FEV1指標分別下降12.80%、11.51%、均值有統(tǒng)計學意義(P0.05)。FVC、MVV及FEV1／FVC指標下降為3.07%、8.70%、0.87%，均值不具統(tǒng)計學意義。最大呼氣流速(PEF)指標下降3.58%，均值無統(tǒng)計學意義(P0.05)。PaO2下降2.91%，均值無統(tǒng)計學意義(P0.05)。結(jié)論：觀察A、B兩組病例經(jīng)胸腔內(nèi)注藥治療惡性胸腔積液前后肺功能及動脈血氣變化表明胸腔內(nèi)灌注IL-2治療惡性胸腔積液未加重患者限制性肺功能障礙，對近期肺功能無負面影響，使胸腔積液得到控制，在一定程度上改善了限制性通氣功能障礙，，并增加了PaO2。B組病例用藥后患者肺通氣功能及肺容量指標較用藥前有所下降，說明BLM胸腔灌注治療惡性胸腔積液后對肺功能有一定程度的不利影響。
[Abstract]:Objective: to observe the changes of pulmonary function and arterial blood gas in patients with malignant pleural effusion after intrapleural injection of interleukin-2 (IL-2) and bleomycin (BLM) injection. To provide reference for safe drug use in clinic. Methods: sixty patients with malignant pleural effusion were divided into two groups: group A (single drug group) and group B (group B). Pulmonary function was compared before and after treatment. Changes of arterial blood gas. Results after treatment, the forced expiratory volume (FEV1) in 1 second of (VC), maximal ventilation volume (FEV1) was increased by 13.767.63 and 10.37, and the mean value was significantly lower than that before treatment (P0.05). The decrease was 4.66 and the mean value was not statistically significant (P0.05). The percentage of forced expiratory volume occupied by vital capacity (FEV1/FVC) was reduced to 15.59. The mean value was statistically significant (P0.05). The maximum expiratory flow rate (PEF) increased by 0. 52 and had no statistical significance (P0.05). The increase of arterial partial pressure of oxygen (PaO2) was 4.89, the mean value was statistically significant (P0.05). The VC,FEV1 index of group B decreased 12.80 and 11.51, respectively. The mean value was statistically significant (P0.05). The index of FEV1/FVC and FEV1/FVC were decreased to 3.07 and 8.70. The mean value was not statistically significant. The maximum expiratory flow rate (PEF) decreased by 3.58, the mean value was not statistically significant (P0.05). PaO2 decreased by 2.91, the mean value was not statistically significant (P0.05). Conclusion: the changes of pulmonary function and arterial blood gas before and after treatment of malignant pleural effusion by intrapleural injection of IL-2 in group A and B showed that the restrictive pulmonary dysfunction was not aggravated by intrapleural perfusion of IL-2 in the treatment of malignant pleural effusion. There was no negative effect on pulmonary function in the near future, so that pleural effusion was controlled, restrictive ventilation dysfunction was improved to some extent, and pulmonary ventilation function and lung volume index were decreased in PaO2.B group after treatment. The results showed that BLM infusion had some adverse effects on pulmonary function after the treatment of malignant pleural effusion.
【學位授予單位】：新疆醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R561.3

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