Müller P, Kuhn M, Leutenegger A, Gartmann J, Hartmann G
Medizinische und chirurgische Klinik, Rätisches Regional- und Kantonsspital, Chur.
Schweiz Rundsch Med Prax. 1991 May 28;80(22):599-604.
A pyothorax is a relatively rare occurrence in a general hospital and is posing a number of problems. Among these the long mean duration of hospitalisation is of note lasting 47 days for 24 patients at our clinic. The course and the mortality rate are influenced by early detection and judicious use of interdisciplinary treatment. Small effusions accompanying pneumonia are frequent and likely to disappear after treatment of the underlying disease. In these instances a precipitate punction may lead to secondary infection. In case of a sterile punctate the pH value and consideration of glucose and LDH values determine further measures. Computed tomography is of great value since it yields decisive information not available from conventional radiography. If the empyema is not segregated in compartments a closed drainage with a large caliber chest-tube ist the method of choice. Limited thoracotomy is advised when several empyema chambers develop after short duration of the illness. Persistent disease or widespread scarring necessitate decortication in most cases.
脓胸在综合医院中相对少见，且存在诸多问题。其中，住院平均时间较长值得关注，我院24例患者的住院时间长达47天。病程及死亡率受早期诊断及合理采用多学科治疗的影响。肺炎伴发的少量胸腔积液很常见，在治疗基础疾病后可能会消失。在这些情况下，贸然穿刺可能导致继发感染。如果穿刺液无菌，pH值以及对葡萄糖和乳酸脱氢酶值的考量决定进一步的治疗措施。计算机断层扫描非常有价值，因为它能提供传统X线摄影无法获得的决定性信息。如果脓胸没有分隔，选择大口径胸管进行闭式引流。如果在疾病短期发作后出现多个脓腔，建议进行有限的开胸手术。在大多数情况下，持续性疾病或广泛的瘢痕形成需要进行胸膜剥脱术。
