目的 观察胸腔闭式引流并注入尿激酶治疗结核性胸膜炎的疗效。方法 将100例渗出性结核性胸膜炎患者随机分为2组，胸腔闭式引流加尿激酶治疗55例为治疗组，经皮胸腔穿刺治疗45例为对照组，两组均应用9HREZ抗结核治疗方案。治疗组胸腔闭式引流同时注入尿激酶1×105 U，保留24 h，每3天1次，2次为1个疗程，治疗2～3个疗程；对照组经皮胸腔穿刺抽出胸水，治疗约28 d，治疗4周后检测两组胸膜厚度及胸水蛋白水平。结果 治疗组总有效率100%，对照组总有效率86.7%，治疗组明显高于对照组（P＜0.01），2组治疗4周后胸膜厚度及胸水蛋白水平差异均有统计学意义（P＜0.05）。结论 结核性胸膜炎并发胸膜腔积液患者行胸腔闭式引流术并按疗程注入尿激酶，可减少并发症的发生，该方法安全、简单、疗效良好，可推广使用。

Objective To observe the effect of closed drainage with injecting the urokinase to the chest on tuberculous pleurisy. Methods One hundred patients with exudative tuberculosis pleuritis were randomly divided into two groups, among which 55 patients were treated by closed drainage with injecting the urokinase to the chest (treatment group), and 45 patients were treated by percutaneous thoracentesis (control group). The 9HREZ treatment program was applied in the two groups of patients. The treatment group should be injected 1×105 U of urokinase into the chest once every 3 d, and be reserved among 24 h (twice for a course while usually two to three couses). The control group was received pleural effusion puncture for 28 d. the pleural thickness and the effusion protein levelt after four weeks’ treatment between treatment and control groups were observed. Results The total effective rate was 100% in the treatment group and 86.7% in the control group, the difference between the two groups was significant (P＜0.01). The pleural thickness and the effusion protein level after four weeks’ treatment in treatment group were significantly lower than those in the control group (P＜0.05). Conclusion The therapy of closed drainage with injecting urokinase to patients suffered from tuberculous pleurisy and pleural effusion, is effective and could reduce the incidence of complications. This method is safe and simple, and can be widely promoted with the good efficacy.