Department of Medical Microbiology, University College London Hospital NHS Foundation Trust, London, UK.
Curr Opin Pulm Med. 2010 May;16(3):194-200. doi: 10.1097/MCP.0b013e32833883f5.
Empyema is defined as pus in the thoracic cavity due to pleural space infection and has a multifactorial underlying cause, although a majority of them are post-bacterial pneumonia caused by tuberculosis or by infection following penetrating chest injuries or surgical procedures. It is still associated with significant morbidity and mortality in adults and children despite optimal management according to current guidelines. Historically, empyema management has been empirical, but more recent data are leading to more focused management guidelines.
The number of therapeutic agents licensed for intrapleural use or undergoing clinical trials in the management of empyema continues to expand, although their use is currently controversial and probably best limited to trials and specialist centers. Although their use is limited by availability, ultrasound and guided aspiration is the investigation of choice in suspected empyema. It is safer, more sensitive, provides more information, and, in the case of guided-drainage, is more likely to be effective. Finally, there is a growing body of literature that supports very early involvement of thoracic surgeons in empyema management. An emerging question for the future is whether some or indeed all patients with empyema should now bypass medical thoracostomy and proceed directly to video-assisted thoracoscopic surgery for both acute and chronic empyemas.
A summary of the most recent opinions and results in thoracic empyema management is outlined. Treatment of empyema can be summarized as appropriate antibiotic therapy combined with medical or surgical pleural space drainage, management of any underlying factors, with further surgery indicated for chronic disease.
脓胸是指由于胸膜腔感染导致的胸腔内脓液，其病因复杂，但大多数是细菌性肺炎后，由结核分枝杆菌或穿透性胸部损伤或手术后继发感染引起。尽管按照现行指南进行了最佳治疗，但成人和儿童的脓胸仍然存在较高的发病率和死亡率。历史上，脓胸的治疗一直是经验性的，但最近的数据为更有针对性的治疗指南提供了依据。
尽管目前对脓胸的治疗仍存在争议，而且可能最好仅限于临床试验和专业中心，但用于脓胸治疗的获准胸膜腔内使用的治疗药物或正在临床试验中的药物数量仍在不断增加。尽管其应用受到供应的限制，但超声和引导下抽吸是疑似脓胸的首选检查方法。它更安全、更敏感、提供更多信息，并且在引导引流的情况下，更有可能有效。最后，越来越多的文献支持胸外科医生尽早参与脓胸的治疗。未来一个悬而未决的问题是，现在是否应该让一些甚至所有脓胸患者绕过内科胸腔镜治疗，直接进行电视辅助胸腔镜手术，无论是急性还是慢性脓胸。
本文概述了最近在脓胸治疗方面的观点和结果。脓胸的治疗可以概括为适当的抗生素治疗，结合内科或外科胸膜腔引流，处理任何潜在的因素，对于慢性疾病则需要进一步手术。
