Cohen D J
Postgrad Med. 1982 Sep;72(3):157-9, 162-7. doi: 10.1080/00325481.1982.11716190.
The incidence and treatment of empyema historically have fluctuated with the introduction of new antibiotics. As resistant strains of bacteria emerge, a return to aggressive surgical therapy becomes necessary. Empyemas are most likely to occur in patients with an underlying factor such as alcoholism, bronchitis, asthma, emphysema, diabetes, tuberculosis, carcinoma, heroin addiction, or steroid therapy. The bacteriology is constantly changing. Recently, the importance of anaerobic organisms--which are now involved in three out of four cases of empyema--has been recognized. Diagnosis is established and antibiotics chosen on the basis of Gram staining and culture of pleural fluid. Surgical procedures include thoracentesis, closed chest tube drainage, open drainage plus rib resection, decortication, thoracoplasty, and excision of the empyema sac with an extrapleural dissection.
从历史上看，随着新型抗生素的引入，脓胸的发病率和治疗方法一直在波动。随着耐药菌的出现，有必要恢复积极的手术治疗。脓胸最容易发生在有潜在因素的患者身上，如酗酒、支气管炎、哮喘、肺气肿、糖尿病、结核病、癌症、海洛因成瘾或类固醇治疗。细菌学也在不断变化。最近，厌氧菌的重要性——现在四分之三的脓胸病例都涉及厌氧菌——已得到认可。根据胸腔积液的革兰氏染色和培养结果进行诊断并选择抗生素。手术程序包括胸腔穿刺术、闭式胸腔引流、开放引流加肋骨切除、胸膜剥脱术、胸廓成形术以及通过胸膜外剥离切除脓胸囊。
