Saitoh Y, Nakamura H, Kagawa K, Umemoto M, Imamura H
Department of Thoracic and Cardiovascular Surgery, Kansai Medical University, Moriguchi, Japan.
Kyobu Geka. 1995 May;48(5):418-21.
The occurrence of pneumothorax in patients with compromised lung function or severe pulmonary disease may be fatal. We describe a 77-year-old patient with MRSA pneumonia complicated by pneumothorax and reduced pulmonary function. Although the patient was treated with drainage of the pleural cavity and nonsurgical pleurodesis, the pneumothorax could not be managed successfully. The patient underwent successful surgical treatment of the pneumothorax on 105 days after onset. The following factors must be considered in the surgical treatment of pneumothrax with reduced pulmonary function in patients with MRSA pneumonia: 1) When there is massive air leakage, adequate doses of VCM should be administered to prevent pyothorax, 2) when conservative treatment fails and surgical treatment becomes necessary, the operation should be instituted only when MRSA has been completely or almost completely eradicated so as to prevent the occurrence of postsurgical pyothorax, and 3) surgical intervention should be limited to what is necessary to repair the site of ruptured bulla; care should be exercised to preserve as much lung parenchyma as possible and to shorten the operation time.
肺功能受损或患有严重肺部疾病的患者发生气胸可能是致命的。我们描述了一名77岁患有耐甲氧西林金黄色葡萄球菌肺炎并并发气胸且肺功能减退的患者。尽管该患者接受了胸腔引流和非手术胸膜固定术治疗，但气胸仍未能成功处理。患者在发病105天后接受了成功的气胸手术治疗。对于耐甲氧西林金黄色葡萄球菌肺炎且肺功能减退的患者进行气胸手术治疗时，必须考虑以下因素：1）当有大量漏气时，应给予足够剂量的万古霉素以预防脓胸；2）当保守治疗失败且有必要进行手术治疗时，应仅在耐甲氧西林金黄色葡萄球菌已被完全或几乎完全根除后进行手术，以防止术后脓胸的发生；3）手术干预应仅限于修复破裂肺大疱部位所需的操作；应注意尽可能保留更多的肺实质并缩短手术时间。
