Alfageme I, Muñoz F, Peña N, Umbría S
Department of Internal Medicine, Valme University Hospital, Seville, Spain.
Chest. 1993 Mar;103(3):839-43. doi: 10.1378/chest.103.3.839.
The etiology, microbiologic findings, and management of 82 episodes of empyema treated by our unit over a period of 6 years were analyzed. Average patient age was 54 years. Eighty-two percent had underlying disease such as alcoholism (29 percent), malignancy (23 percent), and diabetes mellitus (20 percent). Sixty (73 percent) had an empyema develop secondary to a bronchopulmonary infection. Other etiologies were as follows: infradiaphragmatic sepsis, five cases; iatrogenic, ten cases; and idiopathic, seven cases. Cultures were positive in 76 cases and negative in the remaining 6 (2 positive Gram stains, 1 positive under bacilloscopy, and 3 were sterile). Anaerobes were isolated from 25 and aerobes from 47 of the positive cultures. A single bacteria was isolated from 43 and multiple organisms (average: 2.63/case) grew on the remaining 33 positive cultures. Length of hospitalization averaged 37 days. Seven patients received antibiotics only, thoracentesis was performed on three, intercostal chest tube drainage was required in 72, and more aggressive surgery was performed on 12 patients (7 with fibrothorax and 5 with pneumonectomy). Streptokinase was instilled into the pleural space of eight patients with good results. Pleural drainage superinfection occurred at a rate of 8.5 percent. Nine patients died; the remaining recovered. Only three deaths came about as a direct result of the empyema.
对我院6年期间治疗的82例脓胸病例的病因、微生物学检查结果及治疗情况进行了分析。患者平均年龄54岁。82%的患者有基础疾病，如酒精中毒（29%）、恶性肿瘤（23%）和糖尿病（20%）。60例（73%）脓胸继发于支气管肺部感染。其他病因如下：膈下脓肿5例；医源性10例；特发性7例。76例培养结果为阳性，其余6例为阴性（2例革兰氏染色阳性，1例杆菌镜检阳性，3例无菌）。25例阳性培养物分离出厌氧菌，47例分离出需氧菌。43例分离出单一细菌，其余33例阳性培养物生长出多种微生物（平均每例2.63种）。平均住院时间为37天。7例患者仅接受抗生素治疗，3例行胸腔穿刺术，72例行肋间胸腔闭式引流术，12例患者接受了更积极的手术（纤维胸7例，肺切除术5例）。8例患者胸腔内注入链激酶，效果良好。胸腔引流并发感染率为8.5%。9例患者死亡，其余患者康复。仅3例死亡直接由脓胸导致。
