Jébrak G, Pointet P, Pichot M H
Service de Pneumologie et de Réanimation respiratoire, Hôpital Beaujon, Clichy.
Presse Med. 1998 Nov 28;27(37):1924-31.
Purulent collections in the pleural cavity usually occur as complications of pneumonia in immunodeficient or socially underprivileged patients.
The key to diagnosis, pleural aspiration is indicated in case of sufficiently abundant collections, especially in patients with fever. Exploratory puncture is a therapeutic emergency, allowing optimal antibiotic therapy when a causal germ is isolated and drainage of the purulent collection. If there is the slightest doubt, imaging techniques should be used to guide the puncture.
Drainage is essential and is indicated whenever the aspiration fluid is purulent, contains, germs or the chemistry suggests major bacterial colonisation (acid pH, low glucose, high lactic acid dehydrogenase). Local injections of fibrinolytic agents improve drainage.
Complete recovery without sequellae is usually achieved. Physical therapy, provided early and for a prolonged period, helps improve the prognosis. Early care reduces the risk of recurrence of this potentially severe condition.
胸腔积脓通常发生在免疫功能低下或社会经济条件较差的肺炎患者中，是肺炎的并发症。
诊断的关键在于穿刺抽吸，当胸腔积液足够多时应进行穿刺，尤其是对发热患者。诊断性穿刺是一种治疗急症，在分离出致病病原体时可实现最佳抗生素治疗，并对脓性积液进行引流。如果有丝毫疑问，应使用影像学技术引导穿刺。
引流至关重要，当抽吸液为脓性、含有病原体或生化检查提示存在严重细菌定植（酸性pH值、低葡萄糖、高乳酸脱氢酶）时均应进行引流。局部注射纤维蛋白溶解剂可改善引流效果。
通常可实现完全康复且无后遗症。早期并长期进行物理治疗有助于改善预后。早期治疗可降低这种潜在严重疾病复发的风险。
