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題 名 | 伴肺炎性肋膜積水與膿胸的臨床分析 |
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作 者 | 王文炳; | 書刊名 | 中華民國小兒科醫學會雜誌 |
卷 期 | 28:5 民76.09-10 |
頁 次 | 頁321-329 |
分類號 | 415.43 |
關鍵詞 | 伴肺炎性肋膜積水; 膿胸; |
語 文 | 中文(Chinese) |
中文摘要 | 回顧1975年至1985年11年間,在馬偕醫院共有164例伴發於肺炎的肋膜積水及膿胸的病童,經由診斷性肋膜穿刺術證實其中76劍為膿胸,88例為肋膜積水。雖然兩者臨床表徵並無差別,但穿刺液的外觀不同,其醣分及乳酸去氫酵素亦呈有意義的差異,膿胸的醣分、乳酸去氫酵素的平均值分別為27.2±19.2mg/dl及2912±1194 IU/l,相對的肋膜積水為73.6±32mg/dl及736±428IU/l。膿胸常發生於嬰幼兒,75%發生於1歲以下的嬰兒,而肋膜積水則分佈於各年齡層。能確定致病菌者在膿胸有86.8%,其中以S. aureus (50%)最多,在11年中的後5年顯示出S. aureus減少,而H. influenzae及H. parainfluenzae有增加的趨勢。在肋膜積水中能確定病原者僅25%,其中以Pneumococcus (8%)最多。抗生素敏感試驗顯示S. aureus對oxacillin有95%的感受性,對penicillin僅8%,而H. influenzae對ampicillin有80%的感受性。在膿胸中有86%接受抗生素加上肋膜穿刺術及胸管引流術的治療,而肋膜積水患者接受上述治療者有25%,沒有一個病例接受胸膜剝脫術或肋骨切開術。膿胸的死亡率為10.8%,而肋膜積水為1.1%。 |
英文摘要 | During an 11 years period, one hundred and sixty-four cases of infant and childhood pleural effusion and empyema associated with pneumonia were reviewed retrospectively at Mackay Memorial Hospital. Of the 164 cases, there were 76 cases of empyema and 88 cases of pleural effusion. In both instances, the primary diagnosis was made by thoracocentesis. There was no difference in the clinical manifestations of the two groups, but there was a significant difference in the aspirated fluid taken from them. The mean value of the aspirate of LDH and sugar was 2,912±1,194 IU/I, 27.2±19.2 mg/dl in empyema, and 736±428 IU/I, 73.6±32 mg/dl in the pleural effusion. Empyema was more frequently found in younger infants. In this series, three-fourths of them were below one year of age. However, no significant age difference was noted among the patients with pleural effusion. Causative organisms were identified in 86.8% of the empyema cases, and S. aureus isolated in 50% of the cases studied during this period. During the last five years of the study, there was a significant decrease in S. aureus empyema, but a concomitant increase in Hemophilus empyema. Causative organisms were identified in only 25% of the pleural effusion cases, and pneumococcus was the most frequently isolated organism. The sensitive tests showed that 95% S. aureus were sensitive to prostaphlin and 8% were sensitive to, penicillin. Eighty percent H. influenza were sensitive to ampicillin. Besides a thoracocentesis, 86% of the empyema patients received antibiotics and closed chest tube draidage, but only 25% of pleural effusion cases received the above procedures. In this series, no decortication or rib resection was performed. The overall mortality rate was 5.5% with patients having empyema at 10.5% and those diagnosed with pleural effusion at 1.1%. |
本系統中英文摘要資訊取自各篇刊載內容。