肺炎旁积液

Parapneumonic Effusion

肺炎旁积液分为非复杂性和复杂性两种。前者经抗生素治疗多可自行吸收,后者则需要及时插胸管引流。认别两种肺炎旁积液至关重要,延误插管时机会使治疗复杂和棘手。176例细菌性肺炎患者中,67例(38％)合并肺炎旁积液。其中,非复杂性肺炎旁积液56例,复杂性11例。识别复杂性肺炎旁积液我们是根据:1.脓性胸水。2.胸水革兰氏染色或细菌培养阳性。3.胸水pH<7.00,葡萄糖<2.24mmol/L,LDH>1 000IU/L。

Sixty-seven of the 176 patients(38%) with bacterial pneumonia had pleural effu-sions. Fifty-six were uncomplicated parapneumonic effusions and 11 were complica-ted. Of these 56 patients with uncomplicated effusions, pneumococcal pneumonias werefound in 51 (91%). Eleven patients who were classified as complicated parapneumoniceffusions were caused mainly by anaerobic organisms, gram-negative bacilli and stap-hylococci aureus. All uncomplicated effusions resolved spontaneously without the useof chest tube. Complicated effusions, however. needed to institute tube thoracostomyfor resolution. The indications for identifying those patients who need tube thoracostomy as earlyas possible are as follows: 1. grossly purulant effusions, 2. organisms shown on gramstain or positive cultures, 3. pH<7.00; glucose below 2.24mmol/L, and LDH 1 000IU/L.