Varkey B
Postgrad Med. 1986 Oct;80(5):213-6, 219, 222-3. doi: 10.1080/00325481.1986.11699570.
Diagnostic thoracentesis is imperative when pneumonia is accompanied by an effusion (parapneumonic effusion). Examination of the pleural fluid is the only way to differentiate empyema and complicated parapneumonic effusions from uncomplicated parapneumonic effusions, and this differentiation is vital in deciding whether chest tube drainage is needed. If the aspirated pleural fluid contains pus or bacteria, closed chest tube drainage and antibiotic therapy should be started promptly. The same management approach is indicated if the pleural fluid pH is less than 7.00 or the glucose level is less than 40 mg/ml, since these effusions almost invariably are complicated parapneumonic effusions that do not resolve without fluid drainage. If the pleural fluid pH is greater than 7.20 and glucose level is more than 40 mg/ml, antibiotic therapy alone will suffice. Management of parapneumonic effusions with a pH of 7.00 to 7.20 should be based on serial observations of clinical status and pleural fluid findings.
当肺炎伴有胸腔积液（类肺炎性胸腔积液）时，诊断性胸腔穿刺必不可少。检查胸腔积液是区分脓胸、复杂性类肺炎性胸腔积液与单纯性类肺炎性胸腔积液的唯一方法，而这种区分对于决定是否需要胸腔闭式引流至关重要。如果抽出的胸腔积液含有脓液或细菌，应立即开始胸腔闭式引流和抗生素治疗。如果胸腔积液pH值小于7.00或葡萄糖水平低于40mg/ml，也应采取同样的处理方法，因为这些胸腔积液几乎无一例外都是复杂性类肺炎性胸腔积液，不进行液体引流无法自行消退。如果胸腔积液pH值大于7.20且葡萄糖水平高于40mg/ml，仅抗生素治疗就足够了。pH值为7.00至7.20的类肺炎性胸腔积液的处理应基于对临床状况和胸腔积液检查结果的连续观察。
