尿激酶在保持阑尾切除术后腹腔引流管通畅性中的作用研究

Study on the Urokinase in Maintaining Patency of the Peritoneal Drainage After Laparoscopic Appendectomy

关键词:  腹腔引流管通畅性  生理盐水  尿激酶

Key words:  patency of abdominal drainage tube  normal saline  urokinase

摘要:

目的 探讨尿激酶在保持腹腔镜下阑尾切除术后腹腔引流管通畅性中的作用。方法 采用配对的方法将58例腹腔镜下阑尾切除术后放置引流管的患者分为尿激酶组和生理盐水组，尿激酶组23例，术后24 h给予1次尿激酶（500 U·mL^-1）20~50 mL注入腹腔引流管内，0.5 h后开放引流；生理盐水组35例，术后24 h给予1次生理盐水20~50 mL注入腹腔引流管内，0.5 h后开放引流。根据B超检查结果、拔管后敷料渗出结果、测静水压时水柱波动结果、术后48 h引流量、拔管时间以及引流管拔除后管内沉积物情况判断2组实验效果，并结合引流管通畅指标探求术后48 h引流量对引流管通畅性预测意义。结果 2组患者中B超检查结果、拔管后敷料渗出结果、测静水压时水柱波动结果、术后48 h引流量及拔管时间的比较，均具有显著差异（P<0.05）。尿激酶组中拔管前B超检查提示无明显积液比例、拔管后引流管口敷料干燥比例、测静水压时水柱波动比例以及术后48 h引流量均大于生理盐水组，并且尿激酶组的拔管时间均短于对照组。通过Logistic回归分析显示术后48 h引流量对于预测引流管通畅性无显著性差异。结论 尿激酶封管能够有效保持腹腔引流管通畅性，有助于提前拔管，加快患者术后康复进程。

Abstract:

OBJECTIVE To investigate the role of urokinase in maintaining patency of abdominal drainage tube after laparoscopic appendectomy. METHODS Fifty eight patients who placed drainage tube after laparoscopic appendectomy were divided into urokinase group and normal saline group by pairing. Urokinase group included 23 cases, were given once urokinase(500 U·mL^-1) within 24 h after laparoscopic appendectomy, sealing tube by 20-50 mL urokinase for 0.5 h. The normal saline group included 35 cases, was given once normal saline within 24 h after the operation, sealing tube by 20-50 mL normal saline for 0.5 h. According to the results of B-ultrasound examination, the results of dressing's exudation after extubating, the fluctuation of water column when hydrostatic pressure was measured, the flux in the 48 h after operation, the time of extubation and the sediment in the tube after extraction, two groups of experimental results were judged. Combined with drainage tube patency index, the significance of predicting the patency of drainage tube after 48 h of operation was explored. RESULTS The results of B-ultrasound examination in two groups, the results of dressing's exudation after extubating, the fluctuation of water column during hydrostatic pressure, the flux in the 48 h after operation and the time of extubation were compared, had significant statistical differences(P<0.05). Preoperative B-ultrasound examination in the urokinase group showed no significant effusion ratio, dry ratio of drainage tube dressing after extubation, water column fluctuation ratio at hydrostatic pressure and the 48 h flow rate was greater than that of normal saline group. And the extubation time of the urokinase group was shorter than that in the normal saline group. Logistic regression analys showed that the flux in the 48 h after operation had no statistical significance for predicting the patency of drainage tube. CONCLUSION Urokinase can effectively maintain the patency of abdominal drainage tube, facilitates early extubation, speed up the process of postoperative rapid recovery of patients.