肺炎旁胸腔积液和脓胸的管理
Management of parapneumonic effusion and empyema.
作者信息
Hilliard T N, Henderson A J, Langton Hewer S C
机构信息
Bristol Royal Hospital for Children, UK.
出版信息
Arch Dis Child. 2003 Oct;88(10):915-7. doi: 10.1136/adc.88.10.915.
AIMS
To gather data on the clinical presentation of parapneumonic effusion and empyema and to examine the effect of different management strategies on short term outcomes.
METHODS
Retrospective case note review of 48 children admitted to a tertiary unit between January 1998 and March 2001. Effusions were classified into three stages dependent on ultrasound findings.
RESULTS
The stage of effusion was not associated with duration of previous symptoms or length of previous admission. An interventional procedure was performed on median day 2 of admission in 46 children: eight (17%) had an intercostal drain alone, 14 (29%) had an intercostal drain followed by intrapleural fibrinolytic therapy, and 24 (50%) had a thoracotomy. Three children who had an initial intercostal drain alone returned to theatre for thoracotomy, and two children who had intrapleural fibrinolysis returned for thoracotomy. Median length of stay (interquartile range) for each initial procedure was 15 days (6-20) for intercostal drain alone, 8 days (6-12) for fibrinolytic therapy, and 6.5 days (5-9) for thoracotomy. Stay for intercostal drain alone was significantly longer than for thoracotomy.
CONCLUSION
Early surgical management of empyema is associated with a favourable outcome.
目的
收集肺炎旁胸腔积液和脓胸的临床表现数据，并研究不同治疗策略对短期预后的影响。
方法
对1998年1月至2001年3月期间收入一家三级医疗单位的48例儿童进行回顾性病例记录审查。根据超声检查结果将胸腔积液分为三个阶段。
结果
胸腔积液的阶段与先前症状的持续时间或先前住院时间无关。46例儿童在入院中位数第2天进行了介入治疗：8例（17%）仅行肋间引流，14例（29%）行肋间引流后行胸膜腔内纤维蛋白溶解疗法，24例（50%）行开胸手术。3例最初仅行肋间引流的儿童返回手术室行开胸手术，2例行胸膜腔内纤维蛋白溶解疗法的儿童返回行开胸手术。每种初始治疗方法的住院中位数（四分位间距）分别为：仅肋间引流15天（6 - 20天），纤维蛋白溶解疗法8天（6 - 12天），开胸手术6.5天（5 - 9天）。仅肋间引流的住院时间明显长于开胸手术。
结论
脓胸的早期手术治疗与良好的预后相关。
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