Lim T K
Department of Medicine, National University Hospital, Singapore.
Curr Opin Pulm Med. 2001 Jul;7(4):193-7. doi: 10.1097/00063198-200107000-00005.
Parapneumonic pleural effusion is a common and potentially serious complication of pneumonia. The management of parapneumonic pleural effusion involves early diagnosis, adequate empiric antibiotic cover, and appropriate risk categorization. High-risk patients require safe and expedient drainage of the infected pleural space. The management options include thoracentesis, tube thoracostomy, adjunctive intrapleural fibrinolytic therapy, and surgical drainage. The methods of surgical drainage include thoracoscopy, thoracotomy, and decortication. The relative clinical efficacy of these treatment options has been studied in a small number of controlled clinical trials, the results of which have been systematically reviewed by expert panels. Based on the limited clinical evidence, expert reviewers were unable to recommend a best method of pleural drainage. However, the consensus is that an aggressive approach with early surgical drainage results in shorter hospital stays and may be more cost-effective than conservative management. This review discusses the clinical evidence and describes an aggressive sequential management strategy that combines intrapleural fibrinolysis with early surgical drainage.
肺炎旁胸腔积液是肺炎常见且可能严重的并发症。肺炎旁胸腔积液的管理包括早期诊断、足够的经验性抗生素覆盖以及适当的风险分类。高危患者需要安全且迅速地引流感染的胸腔。管理选项包括胸腔穿刺术、胸腔闭式引流术、辅助性胸腔内纤维蛋白溶解疗法以及外科引流。外科引流方法包括胸腔镜检查、开胸手术和胸膜剥脱术。这些治疗选项的相对临床疗效已在少数对照临床试验中进行了研究，专家小组对其结果进行了系统评价。基于有限的临床证据，专家评审无法推荐最佳的胸腔引流方法。然而，共识是早期外科引流的积极方法可缩短住院时间，并且可能比保守治疗更具成本效益。本综述讨论了临床证据，并描述了一种将胸腔内纤维蛋白溶解与早期外科引流相结合的积极序贯管理策略。
