Wiedemann H P, Rice T W
Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Foundation, OH 44195, USA.
Semin Thorac Cardiovasc Surg. 1995 Apr;7(2):119-28.
The problems of lung abscess and empyema were recognized by physicians in ancient times, and continue to pose a challenge for contemporary practitioners. Until the current century, anaerobic bacterial infections were undoubtedly the most common cause of lung abscess and empyema. However, other infectious causes are becoming increasingly common as more patients present with complex comorbidities and/or severe immunosuppression. Most lung abscesses respond to appropriate antimicrobial therapy; only about 10% of patients require external drainage or surgical therapy. Noninfected parapneumonic effusions usually respond to systemic antibiotic therapy alone. However, complete drainage of the pleural space is indicated if an effusion is infected or has the characteristics of frank pus. Some parapneumonic effusions that are not grossly turbid and that have negative cultures are nevertheless "complicated"; that is, these effusions have a high risk for causing pleural loculations unless drained early in their course. Over the past 20 years, it has been demonstrated that chemical analysis of parapneumonic effusions (eg, pH, glucose, LDH) is helpful in identifying apparently noninfected, but nevertheless "complicated," parapneumonic effusions. Optimum diagnosis and management of lung abscess and empyema require the coordinated efforts of thoracic surgeons and medical specialists.
肺脓肿和脓胸问题在古代就被医生们所认识，并且至今仍给当代从业者带来挑战。直到本世纪，厌氧细菌感染无疑是肺脓肿和脓胸最常见的病因。然而，随着越来越多的患者出现复杂的合并症和/或严重免疫抑制，其他感染病因正变得越来越常见。大多数肺脓肿对适当的抗菌治疗有反应；只有约10%的患者需要外部引流或手术治疗。非感染性肺炎旁胸腔积液通常仅对全身抗生素治疗有反应。然而，如果胸腔积液被感染或具有明显脓液的特征，则需要完全引流胸腔。一些外观不浑浊且培养结果为阴性的肺炎旁胸腔积液仍然是“复杂的”；也就是说，这些胸腔积液如果不在病程早期引流，就有很高的导致胸膜粘连的风险。在过去20年中，已经证明对肺炎旁胸腔积液进行化学分析（如pH值、葡萄糖、乳酸脱氢酶）有助于识别看似未感染但仍然“复杂的”肺炎旁胸腔积液。肺脓肿和脓胸的最佳诊断和管理需要胸外科医生和医学专家的协同努力。
