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词汇介绍
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解析
Empyema /,empaɪ'iːmə/
释 义 n. 积脓症
例 句 In lung abscess, percutaneous drainage can result in pleural seeding and possibly empyema. 肺脓疡经皮引流可导致肋膜转移并可能引起脓胸。
概述
概述
脓性渗出液积聚于胸膜腔内的化脓性感染,称为脓胸。按照病病程在4~6周以内为急性脓胸。
1.急性脓胸
主要是由于胸膜腔的继发性感染所致。常见的原因:
(1)肺部感染:约 50%的急性脓胸继发于肺部炎性病变之后。肺脓肿可直接侵及胸膜或破溃产生急性脓胸。
(2)邻近组织化脓性病灶:纵隔脓肿、膈下脓肿或肝脓肿,致病菌经淋巴组织或直接穿破侵入胸膜腔,可形成单侧或双侧脓胸。
(3)胸部手术:术后脓胸多与支气管胸膜瘘或食管吻合口瘘合并发生。有较少一部分是由于术中污染或术后切口感染穿入胸腔所致。
(4)胸部创伤:胸部穿透伤后,由于弹片、衣服碎屑等异物可将致病菌带入胸膜腔,加之常有血胸,易形成化脓性感染。
(5)败血症或脓毒血症:细菌可经血循环到达胸腔产生脓胸,此类多见于婴幼儿或体弱的患者。
(6)其他:如自发性气胸或其他原因所致的胸腔积液,经反复穿裂或引流后并发感染;自发性食管破裂,纵隔畸胎瘤感染,穿入胸腔均可形成脓胸。
2.慢性脓胸
(1)急性脓胸治疗不及时或处理不适当:急性脓胸期间选用抗生素不恰当,或治疗过程中未能及时调整剂量及更换敏感抗生素,脓液生成仍较多,如果此时引流管的位置高低、深浅不合适,管径过细。或者引流管有扭曲及堵塞,引流不畅,均可形成慢性脓胸。
(2)胸腔内异物残留:外伤后如果有异物,如金属碎片、骨片、衣服碎条等残留在胸腔内,或术后异物等残留,则脓胸很难治愈,即使引流通畅彻底也因异物残留而不能清除致病菌的来源而不能治愈。
(3)引起脓胸的原发疾病未能治愈:如果脓胸是继发于肺脓肿、支气管瘘、食管瘘、肝脓肿、膈下脓肿、脊椎骨髓炎等疾病,在原发病变未治愈之前,脓胸也很难治愈,易形成慢性脓胸。
临床表现
急性脓胸患者常有胸痛、发热、呼吸急促、脉快、周身不适、食欲缺乏等症状,如为肺炎后急性脓胸,多有肺炎后1~2周出现胸痛、持续高热的病史。查体可见发热面容,有时不能平卧,患侧胸部语颤减弱,叩诊呈浊音并有叩击痛,听诊呼吸音减弱或消失。白细胞计数增高,中性粒细胞增至80%以上,有核左移,胸部X 线检查因胸膜腔积液的量和部位不同表现各异。少量胸腔积液可见肋膈窦消失的模糊阴影;积液量多时可见肺组织受压萎陷,积液呈外高内低的弧形阴影;大量积液使患侧胸部呈一片均匀模糊阴影,纵膈向健侧移位,脓液局限于肺叶间,或位于肺与纵隔、横膈或胸壁之间时,局限性阴影不随体位改变而变动,边缘光滑,有时与肺不张不易鉴别。有支气管胸膜瘘或食管吻合口瘘者可见气液平面。继发于肺部感染的急性脓胸往往是在肺部感染症状好转以后,又再次出现高热、胸痛、呼吸困难、咳嗽、全身乏力、食欲缺乏等症状,患者常呈急性病容,不能平卧或改变体位时咳嗽,严重时可出现发绀。患侧呼吸运动减弱,肋间隙饱满、增宽,叩患侧呈实音并有叩击痛,如为左侧积液心浊音界不清、如为右侧积液则肺肝界不清,纵隔心脏向健侧移位,气管偏向健侧,听诊患侧呼吸音减弱或消失或呈管性呼吸音,语颤减弱。
Empyema “Necessitated” by Indwelling Pleural Catheter: A Unique Complication复制标题
留置胸腔导管 “必要” 的脓胸: 一种独特的并发症
发表时间:2019-10-28
影响指数:16.5
作者: Sujith V Cherian
期刊:Am. J. Respir. Crit. Care Med.
The patient had been draining the pleural catheter on a daily basis; however he noticed increased pleuritic chest pain and tenderness along the site of insertion for which he presented again a week after insertion of the pleural catheter. He denied any subjective fevers or complaints of cough. The pleural catheter was noted to be in good position with the cuff underneath the skin and showed no evidence of any inadvertent damages. Drainage of the pleural catheter revealed malodorous and purulent fluid and examination revealed crepitus along the right lateral wall of the chest. CT of the chest revealed a necrotizing pneumonia, air fluid opacity in the pleural space and multiple air locules in the chest wall (Figure 3) consistent with empyema necessitans. Extensive debridement of chest wall, drainage of empyema with a new 32 F chest tube, along with removal of tunneled pleural catheter were then emergently performed. Cultures of the pleural fluid and chest wall tissue revealed Streptococcus mitis and Streptococcus constellatus. The patient was subsequently discharged on antibiotics and is recovering slowly.
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