Ultrasonic manifestations and clinical value of fibrous cord separation in pleural effusion of tuberculous pleurisy dissolved by urokinase at different time periods

Objective To observe the effect of intrathoracic injection of urokinase on the separation of fibrous septa in the pleural effusion of patients with tuberculous pleurisy treated by ultrasound, and to explore the time rule and optimal drainage time node of fibrin strip separation in urokinase-dissolved pleural effusion. Methods A total of 147 patients with tuberculous pleurisy and pleural effusion with fiber strips influencing the drainage were selected. According to the full drainage volume on the day, 48 cases were divided into group A (fully diverted flow≤500 ml), 63 cases in group B (fully diverted flow 500~800 ml), and 36 cases in group C (fully diverted flow≥800 ml). All of them were injected with 200,000 units of urokinase. Then we analyzed the images under the guidance of ultrasound at the time points of before injection, and 0.5 h, 1.0 h, 1.5 h, 2.0 h, 2.5 h and 3.0 h after injection. The changes of the number of fibrous septa in pleural effusion at different time points were analyzed. Results After drug injection, the number of pleural effusion fibers in the 147 patients was compared at different time points, and there was a statistically difference (F=34.989, P=0.000). There was a statistical difference between before injection and 1.0 h after injection (t=6.274, P=0.000). There was a statistical difference between 0.5 h and 1.0 h after injection (t=3.300, P=0.001). There was no statistical difference between 1.0 h and 1.5 h, 2.0 h, 2.5 h, 3.0 h after injection (P>0.05). There were statistical differences between 1.0 h after injection in group A, B and C, and 0.5 h before injection and 0.5 h after injection (pre-drug comparison: t=-6.020, -4.331, 8.554; compared with 0.5 h after injection: t=-3.338, 2.613, 5.216; all P 0.05). Conclusion After injection of 200,000 units of urokinase, the fastest dissolution rate of fibrous septa in pleural effusion achieved with the first hour, and the dissolution effect was not obvious at 1.5 h after injection. Ultrasound is an effective method to observe the changes of fibrous septa dissolution in thoracic cavity in real time, and is worthy of clinical application. Key words: Ultrasonography; Tuberculous pleurisy; Septate fiber; Urokinase; Pleural effusion