肺炎旁胸腔积液现状与治疗进展

Current situation and treatment progress of parapneumonic pleural effusion

胸膜腔感染在世界范围内都有很高的发病率和病死率,而且近些年其发病率是逐年上升的.并不是所有的胸膜腔感染都合并肺部疾病,许多患者并不能在胸腔积液中发现病原微生物.一部分患者由于未能及时诊治而演变成复杂性胸腔积液,甚至脓胸,影响了治疗的结局.肺炎旁胸腔积液的治疗要根据细菌的特征、胸腔积液生化分析,做到早期诊断、及时的抗生素治疗和必要的胸水引流.胸腔积液特征,特别是pH值,是评估胸腔积液性质非常有用的指标.纤溶剂能够促进胸水引流和疾病恢复.如果内科保守治疗失败,可选择外科手术治疗,如电视辅助胸腔镜、开胸胸膜剥脱术等.

Pleural cavity infection has high morbidity and mortality in the world,its incidence is increasing in all age groups.Not all pleural infections are associated with lung disease,many patients did not found pathogenic microorganisms in pleural effusion.A part of patients failed to timely diagnosis and volved into complicated parapneumonic pleural effusion or empyema,even affected the treatment outcome.The treatment of parapneumonic pleural effusion should be based on the bacteria characteristics,biochemical analysis of pleural effusion,early diagnosis,timely antibiotic treatment and the necessary pleural drainage.Pleural effusion characteristics,particularly pH,are useful indicators for assessing the nature of pleural effusion.Fibrinolytic agents can promote drainage of pleural effusion and disease recovery.If previous treatment failed,you can consider surgery,such as video assisted thoracic surgery,decortication by thoracotomy.