Sahn Steve A
Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
Clin Infect Dis. 2007 Dec 1;45(11):1480-6. doi: 10.1086/522996. Epub 2007 Oct 24.
Approximately 1 million patients develop parapneumonic effusions (PPEs) annually in the United States. The outcome of these effusions is related to the interval between the onset of clinical symptoms and presentation to the physician, comorbidities, and timely management. Early antibiotic treatment usually prevents the development of a PPE and its progression to a complicated PPE and empyema. Pleural fluid analysis provides diagnostic information and guides therapy. If the PPE is small to moderate in size, free-flowing, and nonpurulent (pH, >7.30), it is highly likely that antibiotic treatment alone will be effective. Prolonged pneumonia symptoms before evaluation, pleural fluid with a pH <7.20, and loculated pleural fluid suggest the need for pleural space drainage. The presence of pus (empyema) aspirated from the pleural space always requires drainage. Fibrinolytics are most likely to be effective during the early fibrinolytic stage and may make surgical drainage unnecessary. If pleural space drainage is ineffective, video-assisted thoracic surgery should be performed without delay.
在美国，每年约有100万患者发生类肺炎性胸腔积液（PPE）。这些胸腔积液的预后与临床症状出现至就医的间隔时间、合并症以及及时治疗有关。早期抗生素治疗通常可预防PPE的发生及其进展为复杂性PPE和脓胸。胸腔积液分析可提供诊断信息并指导治疗。如果PPE体积小至中等、可自由流动且非脓性（pH值>7.30），仅使用抗生素治疗很可能有效。评估前肺炎症状持续时间长、胸腔积液pH值<7.20以及胸腔积液有分隔提示需要进行胸腔引流。从胸腔抽出脓液（脓胸）总是需要引流。纤维蛋白溶解剂在早期纤维蛋白溶解阶段最有可能有效，可能使手术引流不再必要。如果胸腔引流无效，应立即进行电视辅助胸腔手术。
