Alioke Ikechukwuka Ifeanyichukwu, Delia Ibrahim Zira, Edaigbini Sunday Adoga, Etiuma Anietimfon Umoh
Division of Cardiothoracic Surgery, Federal Medical Centre, Abuja, Nigeria.
Division of Cardiothoracic Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
J West Afr Coll Surg. 2022 Oct-Dec;12(4):75-81. doi: 10.4103/jwas.jwas_157_22. Epub 2022 Nov 23.
Empyema thoracis portrays pleural effusion with demonstrable actively multiplying bacteria. It is a significant cause of morbidity, and commonly complicates parapneumonic effusions. It is important to identify those factors that can be used to prognosticate the outcome of its management in our locality so that those that are modifiable could be applied to improve management outcomes.
A prospective cohort study of patients managed for empyema thoracis at the Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria from February 2017 to January 2018 was conducted. Eighty-three patients were enrolled for this study and recruitment into the study included all consecutive patients being managed for empyema thoracis in ABUTH, Zaria during the study period. Data collected included age, gender, aetiology, microbial isolates, BMI, initial and total empyema volumes, and duration before hospital presentation. The patients were subsequently managed and observed, and the outcome of management (duration of drainage and hospital stay, percentage of lung expansion, and need for decortication) was noted.
Patients in the paediatric age group correlated positively with an earlier presentation to the hospital. The duration before presentation correlated positively with the stage of the disease. The duration before presentation and the total empyema volume indexed to body surface area could prognosticate all four outcome parameters assessed. The age and stage of the disease prognosticated the lung expansion and the need for decortication. The initial empyema volume indexed to body surface area prognosticated the length of hospital stay. The presence of complications was a determinant of the need for decortication. Adolescents and adults had 2.1 times increased probability of requiring a decortication for successful management.
The age, stage of the disease, duration before presentation, initial empyema volume indexed to body surface area, and total empyema volume indexed to body surface area can be used to prognosticate the outcome of empyema thoracis. With the onset of complication comes a higher chance of requiring decortication. Children are less likely to require decortication for satisfactory management of empyema thoracis.
脓胸表现为胸腔积液且可证实有活跃繁殖的细菌。它是发病的一个重要原因，常使肺炎旁胸腔积液复杂化。确定那些可用于预测本地脓胸治疗结果的因素很重要，以便那些可改变的因素能被应用于改善治疗效果。
对2017年2月至2018年1月在尼日利亚扎里亚的阿哈穆杜·贝洛大学教学医院（ABUTH）接受脓胸治疗的患者进行了一项前瞻性队列研究。83名患者纳入本研究，研究期间在扎里亚的ABUTH接受脓胸治疗的所有连续患者均纳入研究。收集的数据包括年龄、性别、病因、微生物分离株、体重指数、初始和总脓胸体积以及入院前持续时间。随后对患者进行治疗和观察，并记录治疗结果（引流持续时间和住院时间、肺扩张百分比以及是否需要胸膜剥脱术）。
儿童年龄组患者与更早入院呈正相关。入院前持续时间与疾病分期呈正相关。入院前持续时间和以体表面积为指标的总脓胸体积可预测所评估的所有四个结果参数。疾病的年龄和分期可预测肺扩张情况以及是否需要胸膜剥脱术。以体表面积为指标的初始脓胸体积可预测住院时间。并发症的存在是是否需要胸膜剥脱术的一个决定因素。青少年和成年人成功治疗需要进行胸膜剥脱术的可能性增加2.1倍。
疾病的年龄、分期、入院前持续时间、以体表面积为指标的初始脓胸体积以及以体表面积为指标的总脓胸体积可用于预测脓胸的治疗结果。随着并发症的出现，需要进行胸膜剥脱术的可能性更高。儿童因脓胸得到满意治疗而需要进行胸膜剥脱术的可能性较小。
