摘要目的:比较不同药物胸腔内注入治疗恶性胸腔积液的疗效及安全性。方法:回顾性分析滨州市人民医院2014年6月至2017年3月治疗的恶性胸腔积液患者214例的临床资料，依据治疗方法不同分为单纯引流组26例、顺铂组55例、重组人血管内皮抑制素(恩度)组58例、榄香烯乳组30例、红霉素组45例，比较各组患者近期治疗效果、生活质量改善情况、不良反应发生率、住院费用及远期生存情况。结果:单纯引流组、顺铂组、恩度组、榄香烯乳组、红霉素组近期总有效率分别为23.1%(6/26)、49.1%(27/55)、70.7%(41/58)、46.7%(14/30)、73.3%(33/45)，差异有统计学意义(χ 2＝24.20， P<0.05)，恩度组、红霉素组的近期总有效率均明显高于其他组；单纯引流组、顺铂组、恩度组、榄香烯乳组、红霉素组患者的生活质量评分好转率分别为30.8%、58.2%、84.5%、56.7%、88.9%，差异有统计学意义(χ 2＝37.20， P<0.05)，恩度组、红霉素组好转率均明显高于其他组别；恩度组不良反应发生率最低，仅少数患者出现胸痛、乏力、恶心、发热等(其发生率分别为3.4%、8.6%、5.1%、3.4%)，与其他组差异有统计学意义(χ 2＝12.40、10.40、36.60、15.00，均 P<0.05)。恩度组治疗费用[(3 863.2±163.3)元]明显高于其他组( F＝124.48， P<0.05)；单纯引流组、顺铂组、恩度组、榄香烯乳组、红霉素组1年生存率分别为11.5%、32.7%、65.5%、36.7%、66.7%，差异有统计学意义(χ 2＝28.70， P<0.05)，两年生存率分别为3.8%、5.5%、13.8%、6.7%、15.6%，差异无统计学意义(χ 2＝5.28， P＝0.26)；四组注入药物患者的生存期均高于单纯引流组( F＝54.40， P<0.05)，恩度组及红霉素组明显高于其他组( P<0.05)。 结论:胸腔内注入恩度或红霉素可明显提高恶性胸腔积液患者的近期疗效及远期生存率，并可有效改善患者的生活质量；注入红霉素住院费用较低，但胸痛、发热等不良反应发生率较高；注入恩度不良反应发生率较低，但治疗费用较高。

abstractsObjective:To compare the efficacy and safety of injecting different drugs into pleural cavity for treating malignant pleural effusion.Methods:The clinical data of 214 patients with malignant pleural effusion from June 2014 to March 2017 were retrospectively analyzed.According to different treatment method, the patients were divided into simple drainage group(n=26), cisplatin group( n=55), endostar group( n=58), elemene emulsion group( n=30) and erythromycin group( n=45). The recent curative effect, life quality improvement, incidence of adverse reaction, hospitalization expense and the long term survival rate were compared between the two groups. Results:The recent overall effective rates of the five groups were 23.1%(6/26), 49.1%(27/55), 70.7%(41/58), 46.7%(14/30), 73.3%(33/45), respectively, there was statistically significant difference among the five groups(χ 2=24.20, P<0.05). The overall effective rates of the endostar group and the erythromycin group were obviously higher than those of the other three groups(all P<0.05). The live quality improvement rates of the five groups were 30.8%, 58.2%, 84.5%, 56.7% and 88.9%, respectively, there was statistically significant difference among the five groups (χ 2=37.20, P<0.05). The improvement rates of the endostar group and the erythromycin group were obviously higher than those of the other three groups(all P<0.05). In terms of adverse reaction, the incidence of adverse reaction of endostar group was the lowest, only a few patients presented chest pain, weakness, nausea and fever, the incidences were 3.4%, 8.6%, 5.1%, 3.4%, respectively, compared with the other groups, the differences were statistically significant(χ 2=12.40, 10.40, 36.60, 15.0, all P<0.05). The expense of the endostar group [(3 863.2±163.3)CNY] was obviously higher than those of the other groups ( F=124.48, P<0.05). The one-year survival rates of the five groups were 11.5%, 32.7%, 65.5%, 36.7% and 66.7%, respectively, there was statistically significant difference among the five groups (χ 2=28.70, P<0.05). The 2-year survival rates of the five groups were 3.8%, 5.5%, 13.8%, 6.7% and 15.6%, respectively, there was no statistically significant difference among the five groups(χ 2=5.28, P=0.26). The survival period of the four groups injected with different drugs were longer that of the than simple drainage group( F=54.40, P<0.05), the survival periods of the endostar group and the erythromycin group were obviously higher than those of the other groups(all P<0.05). Conclusion:Through injecting endostar or erythromycin into pleural cavity, the recent curative effect and forward survival rate of patients with malignant pleural effusion can be obviously improved, and the life quality of patients can be improved as well, therefore it is worthy of popularizing.Through comparing these two methods, the hospitalization expense of injecting erythromycin is lower, but the incidence rate of adverse reactions including pain and fever is higher, and the incidence rate of adverse reaction of injecting endostar is relatively lower, but the treatment expense is higher.