Na Moon Jun, Dikensoy Oner, Light Richard W
Division of Allergy, Pulmonary, and Critical Care Medicine of Vanderbilt University, Nashville, Tennessee, USA.
Tuberk Toraks. 2008;56(1):113-20.
Despite treatment with antibiotics, patients with complicated parapneumonic effusion (PPE) and empyema have an increased morbidity and mortality due at least in part to inappropriate management of the pleural effusion. PPE should be considered in all patients with pneumonia as antibiotic therapy is being initiated. If the diaphragms cannot be seen throughout their length on the chest radiographs, a lateral decubitus radiograph, ultrasonography or computerized tomography scan should be obtained. If the effusion is more than 10 mm in thickness, a therapeutic thoracentesis should be performed. If the fluid cannot all be removed and the characteristics of the pleural fluid indicate a poor prognosis, a chest tube should be inserted. If the drainage is incomplete due to loculation of the PPE intrapleural fibrinolytics or thoracoscopy should be performed. If the lung does not reexpand completely with thoracoscopy, then decortication should be performed without delay.
尽管使用了抗生素治疗，但复杂性类肺炎性胸腔积液（PPE）和脓胸患者的发病率和死亡率仍有所上升，这至少部分归因于胸腔积液的管理不当。在开始抗生素治疗时，所有肺炎患者均应考虑PPE。如果在胸部X光片上看不到整个膈肌，则应进行侧卧位X光片、超声检查或计算机断层扫描。如果胸腔积液厚度超过10毫米，应进行治疗性胸腔穿刺术。如果液体不能全部抽出，且胸腔积液的特征表明预后不良，则应插入胸管。如果由于PPE胸膜腔内纤维蛋白溶解或应进行胸腔镜检查而导致引流不完全。如果胸腔镜检查后肺未完全复张，则应立即进行胸膜剥脱术。
