Empyema
Introduction
Introduction to empyema Empyema refers to the invasion of the pleural cavity by pathogenic bacteria and the occurrence of infection and empyema. From newborn to elderly, any age can occur. The empyema is caused by purulent bacteria. Most empyema is secondary to lung infections. In children, Staphylococcus aureus pneumonia is a common cause. Some may also be caused by open chest trauma, intrathoracic surgery, underarm abscess or sepsis. Pus occupy the entire chest, called the full empyema, such as pus confined to part of the chest, it is called localized (enveloped empyema). Discharge pus to promote early expansion of the lungs. Early pleural puncture, extraction of thin pus, injection of antibiotics or cellulose-soluble drugs (such as trypsin, streptokinase, deoxyribonuclease) in the thoracic cavity. Thoracic closed drainage should be performed as soon as possible after repeated puncture. The empyema caused by staphylococcal pneumonia in children advocates early closed thoracic drainage, which can achieve better results. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: cough
Cause
Cause of empyema
Pulmonary infection (20%):
About 50% of acute empyema is secondary to inflammatory lesions in the lungs. Lung abscess can directly invade the pleura or ulceration to produce acute empyema. Mediastinal abscess, underarm abscess or liver abscess, pathogenic bacteria can be formed into unilateral or bilateral empyema through lymphatic tissue or directly through the pleural cavity.
Postoperative infection (20%):
Postoperative empyema occurred in combination with bronchopleural fistula or esophageal anastomotic leakage. A small percentage is due to intraoperative contamination or postoperative incision infection into the chest. After the chest penetrating injury, due to the foreign matter such as shrapnel and clothes debris, the pathogenic bacteria can be brought into the pleural cavity, and often there is a hemothorax, which is easy to form a purulent infection.
Other (10%):
Such as spontaneous pneumothorax, or other reasons caused by pleural effusion, repeated puncture or drainage after infection; spontaneous esophageal rupture, mediastinal teratoma infection, penetration into the chest can form empyema.
Prevention
Empy chest prevention
(1) Control of infection: According to the pathogen and drug susceptibility test, an effective amount of antibiotic is selected, and intravenous administration is good, and the therapeutic effect is observed and the drug and dosage are adjusted in time.
(B) the exclusion of pus: is the key to empyema treatment. Infants under one year of age can be treated with puncture and intrathoracic injection of antibiotics, and more satisfactory results can be obtained. Patients with older age should be treated with closed thoracic drainage as soon as possible, draining pus and promoting early expansion of the lungs. Care must be taken to select a drainage tube with appropriate texture and caliber to ensure smooth and effective drainage.
Complication
Epileptic complications Complications cough
The cellulose in the pus deposits on the pleura, and the capillaries and fibroblasts in the pleura grow into the granulation tissue, which becomes a thick and dense capsule, ie the pleural fiberboard. Period. The extensive, hard pleural fiberboard wraps the lung tissue and severely restricts the movement of the thorax, causing the thoracic invagination, mediastinal shift, and severely reduced respiratory function. Has always caused diseases in the respiratory system.
Symptom
Acne symptoms common symptoms chest pain high fever loss of appetite lung purulent infection scoliosis low heat finger (toe)
Mainly manifested as acute inflammation of the chest and effusion symptoms, often high fever, chest pain, chest tightness, shortness of breath, cough, loss of appetite, general malaise, fatigue and so on. The symptoms of infection in the empyema after infant pneumonia are more obvious. When the abscess of the lung abscess or adjacent tissue breaks into the chest, there is often sudden severe chest pain and difficulty breathing, chills, high fever, and even shock. Postoperative empyema patients often have high fever and chest symptoms after the postoperative surgical heat has subsided.
Examine
Examination of empyema
1. The diagnosis of empyema must be done by chest puncture. And for smear microscopy, bacterial culture and antibiotic sensitivity test, according to the selection of effective antibiotic treatment.
2. The physical appearance of the face can be seen, sometimes not lying down, the chest tremor is weakened on the affected side, the percussion is voiced and there is a slap pain, and the auscultation breath sounds weaken or disappear.
3. The white blood cell count is increased, the neutrophils are increased to more than 80%, and the nucleus is shifted to the left.
4. Chest x-ray examination varies according to the amount and location of pleural effusion.
Diagnosis
Diagnosis of empyema
1. Acute empyema :
(1) History of pneumonia, chest trauma or chest surgery, fever, chest pain, cough, shortness of breath, increased white blood cell counts and neutrophil counts.
(2) There is a pleural effusion fluid sign, and more empyema may have a mediastinal shift.
(3) Chest X-ray examination showed effusion in the thoracic cavity. When the mediastinum was pushed to the healthy side and accompanied by bronchopleural pleural effusion, lung atrophy and fluid level were seen.
(4) Thoracic puncture can be diagnosed by pus extraction, and bacterial culture can be positive. After the chest is worn, 1 ml of methylene blue (methylene blue) can be injected to determine the presence or absence of bronchopleural palsy.
2. Chronic empyema :
(1) There is a history of improper treatment of acute empyema or poor drainage, or a history of unresected primary source of empyema, and the abscess has not been closed.
(2) Chronic depletion of body constitution, low fever, thickening of the pleural effusion of the affected side, depression of the chest wall or accumulation of fluid. There are often clubbing fingers (toes).
(3) Chest X-ray examination: thoracic depression, thickening of the pleura, narrowing of the intercostal space, and effusion or liquid-liquid surface. The chest wall sinus iodized oil angiography showed abscess. Chest calcification is sometimes seen.
(4) Thoracic puncture to extract pus, cultured with bacterial growth. Intrathoracic injection of methylene blue can be used to determine the presence or absence of bronchopleural palsy.
