Lewis K T, Bukstein D A
Am Fam Physician. 1992 Nov;46(5):1443-55.
Parapneumonic effusion can be a significant problem if it is not recognized and treated promptly. The amount of pleural fluid at presentation is usually small and may not be detected on physical examination. If pleural fluid is seen on radiographs, thoracentesis must be performed. Early, free-flowing parapneumonic effusions usually respond clinically to antibiotic therapy without the necessity of draining the pleural space. Distinguishing between exudative effusion and empyema is crucial. Failure of effusion or empyema to respond to the treatment is usually due to failure to adequately drain the pleural space or inappropriate antibiotic therapy. If chest tube drainage does not result in a lower temperature and an appropriate clinical response within a few days, further evaluation by computed tomographic scanning and surgical consultation are indicated. In patients with pleural effusion and empyema that responds poorly to medical and/or surgical therapy, underlying causes or associated debilitating disease should be excluded.
如果未被及时识别和治疗，肺炎旁胸腔积液可能会成为一个严重问题。就诊时胸腔积液量通常较少，体格检查可能无法检测到。如果在X线片上看到胸腔积液，必须进行胸腔穿刺术。早期、自由流动的肺炎旁胸腔积液通常对抗生素治疗有临床反应，无需引流胸腔。区分渗出性胸腔积液和脓胸至关重要。胸腔积液或脓胸治疗无效通常是由于胸腔引流不充分或抗生素治疗不当。如果胸腔闭式引流在几天内未导致体温降低和出现适当的临床反应，则需通过计算机断层扫描进一步评估并进行外科会诊。对于胸腔积液和脓胸患者，若对内科和/或外科治疗反应不佳，应排除潜在病因或相关的衰弱性疾病。
