小兒膿胸之臨床觀察－最近10年間在臺在小兒科就治的167例

Pyothorax in Infants and Children: A Review of 167 Cases during the 10 Year Period of 1957-1966

謝貴雄(Kue-Hsioung Hsieh) ； 李慶雲(Chin-Yun Lee)

《Acta Paediatrica Sinica》 8卷3期 (1967/09) Pp. 144-148

摘要

1.從民國46年(1957)1月到55年(1966)12月的10年間有167例膿胸病兒在臺大醫院小兒科住院，其中13例死亡，則病例死亡率爲7.8%。
2.每年之膿胸住院數及其在住院總病例數之比率高低不一，未有逐年增加之趨勢。一年中以4月及9月較爲多見。
3.膿胸病側以右側較多(59.3%)。
4.膿胸兒之平均年齡爲3歲2個月，3歲以下者約佔總病例數之2/3，1歲以下者佔1/3。
5.膿胸常在上呼吸道感染或肺炎後發生，且常見疹麻，癤病或蜂窩組織炎等之存在。
6.膿胸之病原菌：葡萄球菌佔42.5%；肺炎球菌4.0%；鏈球菌3.6%；葡萄球菌和鏈球菌混合0.6%；鏈球菌和肺炎球菌混合0.6%；培養陰性者48.7%。
7.葡萄球菌膿胸之65%發生於未滿1歲嬰兒。死亡例之70%是由葡萄球菌所引起。
8.比較有效的膿胸治療，是應用胸腔引流，膿的細菌培養及其對抗生素之感受性試驗以選擇有效的抗生素。對葡萄球菌性膿胸，半合成盤尼西林似是較有效的抗生素。

並列摘要

1. There were 167 cases of Pyothorax admitted to the Pediatric Ward of National Taiwan University Hospital during the 10 year period from Jannary 1957 to Decemter 1966. Thirteen of them died making a case fatality rate of 7.8%.
2. The number of annual admission of pyothorax patients varied from year to year showing no evidence of gradual increase since 1957. More cases were admitted to the hospital in April and September than in other months of the year.
3. The pyothorax more often occurred on the right side (59.3%) than on the left.
4. The average age of the patients with pyothorax was 3 years and 2 months. Those patients under 3 years of age accounted for two thirds and those under one year for one third of the total cases.
5. The pyothorax most frequently occurred following upper respiratory infection or pneumonia, and often associated with measles, furuncles or/and cellulitis.
6. Bacteriologically, 42.5% of the cases were found to be due to hemolytic coagulase positive staphylococcus, 4.0% to pneumococcus, 3.6% to streptococcus, 0.6% to staphylococcus, and streptococcus and 0.6% to streptococcus and pneumococcus, while the remaining 48.7 % showed no growth on cultures of the pleural fluids.
7. Sixty-five percent of the staphylococcal pyothorax occurred in infants under one year of age and 9 of the 13 fatal cases (70%) were due to staphylococcal infection.
8. The most effective treatment for pyothorax seemed to be the administration of the most appropriate antibiotics decided by sensitivity test with the causative microorganism combined with chest-tube drainage if necessary. The semisynthetic penicillins were found to be the drugs of choice agaisnt staphyio coccal infections in this study.