胸心外科教学课件积脓(胸)英文双语教学课件

1、Empyema积脓（胸）1 Definition2 Etiology 3 Pathway of pathogen 4 Pathology 5 Clinical classificationCommon introductionDefined as a pleural infection 感染 and pleural space suppurative 化脓性 fluid collection（均为胸膜腔）Pleural cavity, pleural space or pleural sacAnatomy Empyema thoracic 脓胸 is characterized by pres

2、ence of pus 脓 or microorganism in the pleural fluid Pus in the pleural cavity. 1 Definition2 Etiology 3 Pathway of pathogen 4 Pathology 5 Clinical classificationCommon introductionEmpyema is caused by an infection of the structures surrounding the pleural space. Risk factors include: bacterial pneum

3、onia the most common cause lung abscess 肺脓肿 thoracic surgery 胸科手术 trauma to the chest thoracentesis 胸腔穿刺 subdiaphragmatic infections 膈下感染Causes and risk factors: Parapneumonic Empyema 脓胸 EtiologyAnaerobes 厌氧菌 are involved in approximately 50% of empyemas and are usually associated with aspiration 抽吸

4、/倒吸, and dental 牙的 or lung abscessesApproximately 25% of infections are polymicrobial 多种微生物的Post-surgical empyemas are usually monomicrobial 单微生物的, caused by typical nosocomial 医院的 pathogens (Staphylococcus aureus 金葡菌)Pathogen include the following: Streptococcus pneumoniae 肺炎链球菌 Streptococcus 链球菌 S

5、taphylococcus aureus 金黄色葡萄球菌 Escherichia coli bacteria 大肠埃希菌 Bacillus pyocyaneus 绿脓杆菌 Fungus 真菌 Anaerobic bacteria 厌氧菌 Mycobacterium 分枝杆菌 Tuberculosis 结核Streptococcus pneumoniae StreptococcusStaphylococcus aureusFungusAnaerobic bacteriaMycobacterium, Tuberculosis 1 Definition2 Etiology 3 Pathway of

6、pathogen 4 Pathology 5 Clinical classificationCommon introductionDept. Cardiothoracic surgeryPathway of pathogen into pleural cavity1.Direct involvement pneumonia, lung abscess2.Lymphatic drainage liver abscess subphrenic 膈下 abscess3.Blood stream 流动 septicemia 败血症, sepsis 脓毒病1 Definition2 Etiology 3

7、 Pathway of pathogen 4 Pathology 5 Clinical classificationCommon introductionParapneumonic Empyema PhysiopathologyAccumulation of fluid in the pleural cavity, secondary to an infectious process of the lung.Exudative Phase 渗出期: early, acuteFibrino-purulent Phase 纤维脓性期: late, transitional 过渡的Fibrinoge

8、nic Phase 纤维蛋白原期: chronic, organizing 组织的 Phase1 Exudative phase ,acute phaseThis is the immediate response with outpouring 流出 of the fluid. The cellular content of the exudates is relatively low. During this stage the fluid is thin and lungs are readily 容易的 re-expandable 再膨胀. Gram stain 革兰染色 and cu

9、lture 培养 is negative for micro-organism. Phase1Dept. Cardiothoracic surgeryPhase 2 Fibrinopurulent phase /transitional phase Phase 2In this stage a large number of poly-morphonuclear leukocytes 分叶核白细胞 and fibrin 纤维蛋白 accumulate in the effusion. With continued accumulation of neutro-phils 中性粒细胞 and f

10、ibrin, effusion becomes purulent.There is progressive tendency towards loculations 形成小腔 and formation of a limiting membranes. Gram stain and culture reports show microorganism.Phase 3 Organizing phase ,chronic phasePhase 3Fibro-blasts 成纤维细胞 grow into exudates on both the visceral and parietal pleur

11、al surfaces 脏壁胸膜表面, producing an inelastic membrane 非弹性膜 “the peel 皮. Thickened pleural peel may prevent the entry of anti-microbial drugs in the pleural space and in some cases can lead to drug resistance. A thickened pleural peel can restrict 限制 lung movement and it is commonly termed as 称为 trappe

12、d lung 陷闭肺. Calcification 钙化, fixedIn empyema, pathological response may be divided into three phases.These phases are not sharply distinctive 有特色的 but gradually one phase merges into 并入 another depending largely on the nature of infecting organism. 1 Definition2 Etiology 3 Pathway of pathogen 4 Pat

13、hology 5 Clinical classificationCommon introductionAcute ChronicLocalized 局限 Diffuse 扩散Dept. Cardiothoracic surgeryEmpyema1 Definition2 Clinical manifestation and diagnosis3 TreatmentAcute EmpyemaExudative phase /acute phaseThis is the immediate 即刻 response with outpouring 流出 of the fluid. The cellu

14、lar content of the exudates is relatively low. During this stage the fluid is thin and lungs are readily re-expandable.1 Definition2 Clinical manifestation and diagnosis3 TreatmentAcute Empyema Clinical signs and physical findings vary depending on the type of organism isolated 隔离, age of the patien

15、t, stage of the empyema and type of prior 先前的 antibiotic therapy.Dept. Cardiothoracic surgeryClinical Manifestation and DiagnosisCommon symptoms chills, fever, dyspnea, chest pain or referred pain, night sweat 盗汗, malaise 萎靡, cough and increased sputum productionPhysical examination findings can var

16、y as well.Auscultation 听诊 reveals rales 啰音,decreased breath soundspossibly a pleural rub 胸膜摩擦音.Physical examination findings :Dullness 浊音 to percussionFocal 病灶 chest wall heat, erythema 红斑, swelling, splinting 夹板固定 of the chest or a preference to lie on the affected side may be noticedDeviation of t

17、rachea 气管偏向Dept. Cardiothoracic surgeryDept. Cardiothoracic surgeryHematological and Biochemical InvestigationThere can be leukocytosis 白细胞增多 with poly-morphonuclear cells predominance 优势. Patients with lower hemoglobin, low serum albumin 血清白蛋白 and abnormal liver function test.Pus examination Dept.

18、Cardiothoracic surgeryPus smear 涂片Pus cultureDept. Cardiothoracic surgeryX-ray ChestCT scanCT chest usually differentiates empyema from consolidation 合并（？） and lung abscess.EmpyemaUltrasound scanUsed to confirm presence of fluid in pleural space Thoracentesis胸腔穿刺术Needle thoracentesis for chemistry a

19、nalysis and culture is usually the initial diagnostic (and occasionally therapeutic 治疗的) step coincident 一致的 with the initiation of intravenous 静脉注射 antibiotics. Thin exudates can occasionally be completely evacuated 排出 with this maneuver 机动/演习（？）. patient is usually toxic productive cough and chest

20、 pain chest X-ray and CT scan may show features suggestive of a pleural effusion ultrasound to confirm presence of fluid in pleural space confirmation of the diagnosis can be obtained by aspirating 吸 pus.Diagnosis1 Definition2 Clinical manifestation and diagnosis3 TreatmentAcute EmpyemaThe managemen

21、t of acute empyema involves three core principles:1. Prompt 迅速 initiation of appropriate antibiotics according to the drug sensitivity of pathogen2. Complete evacuation of suppurative pleural fluid3. Preservation 保留 or restoration of lung expansion Treatment for acute empyemaClosed drainage 闭式引流(clo

22、sed-tube thoracostomy 闭管胸廓造口术)Patients with pleural effusion or frank pus on thoracentesis should undergo immediate insertion of a dependent, large closed-tube drainage catheter 导管. If the effusion has not yet loculated 有分隔的, full lung expansion with obliteration 闭塞 of the empyema space will usually

23、 be achieved following chest tube insertion. Chest tube insertion drainage is the most important treatment for empyema patients.Rib resection 肋骨切除术 open drainage technique Used in adults for empyemas not responding to closed-tube thoracostomyCure criterion The pus drained entirelyThe residual 剩余的 ca

24、vity vanished 消失The lung was fully re-expanded1 Definition2 Causes 3 Clinical manifestation and diagnosis4 TreatmentChronic EmpyemaFibro-blasts grow into exudates on both the visceral and parietal pleural surfaces, producing an inelastic membrane the peel. Thickened pleural peel may prevent the entr

25、y of anti-microbial drugs in the pleural space and in some cases can lead to drug resistance. A thickened pleural peel can restrict lung movement and it is commonly termed as trapped lung. 1 Definition2 Causes 3 Clinical manifestation and diagnosis4 TreatmentChronic EmpyemaCauses of chronic empyema

26、1 Failure to early aggressive treatment of acute empyema leads to chronicity 慢性 inappropriate drainage2 Neglected 被忽视的 foreign body3 Coexistence 共存 of bronchopleural fistula 支气管胸膜瘘 or esophageal fistula 食管瘘4 Specific microorganism infection such as tuberculosis, fungus, etc.1 Definition2 Causes 3 Cl

27、inical manifestation and diagnosis4 TreatmentChronic EmpyemaClinical Manifestation and DiagnosisChronic “toxic” symptoms: persistent low fever, loss of appetite 食欲, weakness, anemia 贫血, low serum albuminRespiratory symptoms: shortness of breath, cough, purulent sputumBronchopleural fistula 支气管胸膜瘘sym

28、ptomsX-ray Chest FilmsCT scan filmsBronchopleural fistula1 Definition2 Causes 3 Clinical manifestation and diagnosis4 TreatmentChronic EmpyemaSurgical Treatment Three core principles should be followed for the treatment of chronic empyema .1.To improve the patients general conditions, to correct chronic toxic symptoms and malnutrition 营养不良2.To eliminate 消除 the primary chronic causes 3.To obliterate 消灭 purulent space, restore lu