The symptoms of empyema
All forms of acute pleural empyema are commonSymptoms: cough with phlegm, shortness of breath, chest pain, fever and signs of intoxication. According to modern concepts, clinic empyema fit into the picture of the syndrome of severe systemic response to inflammation, which in untimely medical events can give rise to the development of sepsis and multiple organ failure.
When closed empyema accompanied by coughrelease of small amounts of sputum. Long-term and frequent cough with sputum compartment significant amount, usually indicate the presence bronchopleural fistula. A particularly large amount of phlegm, patients are separated in position on the healthy side, when the conditions are created to improve the drainage of pus.
In total empyema patients because of severe painshortness of breath and can not lie down and accept half-sitting position. When delineated empyema pain less pronounced. Without taking a forced situation, patients often lie on the affected side of the chest, which limits her breathing excursions, and with it decreases the pain.
The majority of patients are short of breath at rest,cyanosis of the lips and hands, indicating severe respiratory distress, oxygen starvation and acidosis. The pulse is usually speeded up 110-120 in 1 min. Body temperature is usually high, and sometimes, especially when the non-putrid and anaerobic clostridial infections is hectic nature. The clinical picture is similar to sepsis (requires repeated crops in detecting infection). With a positive result, we can confidently talk about sepsis. The lack of reaction temperature usually indicates an areactivity the body, but does not rule out sepsis.
In the study of chest marklag affected half breathing. Intercostal spaces widened and flattened due to the pressure of fluid and relaxation intercostal muscles. When comparing the two folds of skin taken at places symmetrical on both halves of the chest, it may be noted that on the affected side skin fold slightly thicker and more painful study.
In the formation of subpektoralnoy cellulitis soft tissues of the chest wall in the area of starting a breakthrough of pus from the pleura become dense, painful palpation; subsequently appears fluctuation.
For accumulation of fluid in the pleural cavitycharacterized by weakening or absence of voice tremor and respiratory sounds. Percussion pleural effusion can be determined by its content of not less than 250-300 ml of fluid. If the contents of the pleural cavity is the only fluid, the upper limit of the stupidity of line-Ellis Damuazo-Sokolova. The accumulation of large amounts of pus leads to a shift of the mediastinum to the healthy side, and compression of the healthy lung. Therefore, at the bottom of the spine on the healthy side define a triangular shaped section shortening percussion sound (Grokko-Rauhfussa triangle). Liquid and partially pushes kollabiruet cortical regions of the lungs.
With circumscribed collection of pus empyema percussion sometimes difficult to determine.
When pneumoempyema reveal a dull percussionsound above the section with the top horizontal border, the corresponding accumulation of pus, and tympanic sound of air accumulating section. Auscultation define weakening or almost complete absence of respiratory noise and enhanced bronhofoniya in congestion zone of exudate. In the presence of Bron-hoplevralnogo fistula and well-drained through a bronchus cavity increased bronchial breathing mark (amforicheskoe) due to resonance, which creates a large cavity during the passage of air through the bronchial fistula.
In the blood, there is a high leukocytosis (over 10 000), a sharp shift in leukocyte formula to the left, increasing the ESR. Often anemia observed.
The development of pleural empyema accompanied by a breachFunctions of the cardiovascular system, respiratory, hepatic, renal, and endocrine glands. These disorders may develop acutely or gradually. Especially severe violations occur when a breakthrough in the pleural cavity of lung abscess, having a wide connection with pneumatic ways. This occurs when pneumoempyema accompanied by severe disorders that can be characterized as a shock.
Large violations detected in the protein and the water-salt metabolism.
Often changing the immunoreactivity of the organism. Go down humoral and cellular immunity, as in any heavy purulent process.
Along with symptoms characteristic of empyemapleura, some forms it has its own peculiarities. Delimitation empyema characterized by pain and shortening of the percussion sound only in the accumulation of pus. When apical empyema often noted swelling of the arm, and supraclavicular area, the phenomenon plexitis, Horner's syndrome. When basal pleurisy pain localized in the lower chest, upper quadrant, the upper abdomen. The pain often radiates to the shoulder blade, arm and other parts of the body, depending on whether the nerve involved in the inflammatory process.
Treatment of empyema
Regardless aetiologies and forms an acute pleural empyema in the treatment is necessary to ensure:
- early full removal
fluid from the pleural cavity using a puncture or drainage
- early application of a constant unfolding lung
aspiration, medical gymnastics (inflating rubber balloons, etc.
d).; as a result of the unfolding of the lung visceral and parietal
pleura come in contact, and is their spayanie
empyema cavity is eliminated;
- rational antibiotic
therapy (local and general);
- maintenance therapy - increased food.
transfusion of blood components (for anemia, hypoproteinemia,
hypoalbuminemia) and blood liquids. Do not forget
maintenance of heart activity corresponding appointment
drugs. Prior to determining the sensitivity of microorganisms to antibiotics
expediently at first punctures administered broad-spectrum antibiotics
Actions that inhibit both aerobic and anaerobic microflora:
latest-generation cephalosporins (ceftazidime Fortum, et al.),
carbapenems (Tien, imipenem, and others.), metronidazole, or preservatives
(100 mg dioxidine 100-150 ml of saline and al.). at
tuberculous empyema tuberculostatic administered drugs.
free empyema pleural lavage used constant
cavity through two tubes (pleural lavage). antiseptic liquid
tube inserted through the low back (the seventh or eighth intercostal space), and
aspirated - through verhneperednyuyu (installed in the second intercostal space).
After 2-3 days after the improvement of suctioning is carried out through both
tube and achieve the full unfolding of the lungs. In the presence of bronchial fistula this method is contraindicated due to the possibility of liquid entering into the bronchial tree.
thoracotomy with resection edges, debridement of the pleural cavity and
followed by draining only shows the presence of large
seizures and blood clots clotted. If you suspect the presence of
several plots demarcated empyema shows Videothoracoscopy
to conduct a thorough removal of strata fibrin destruction
differentiating moored, pleural lavage
antibacterial agents and the subsequent drainage.
A similar procedure is carried out in the presence of large seizures and
clots in the pleural cavity, the need for
decortication of the lung. Thoracotomy indicated if no
VATS equipment. In the absence of the effect of these
measures where it is evident that a slight, immured
pleural scarring (moored), it is impossible to spread, shows
Early decortication of the lung (thoracotomy with removal of the modified
Visceral pleural adhesions or berths), which leads to a rapid
straightening easy and obliteration of the pleural cavity.