Prognosis of Surgical Management of Adult Patients with Empyema Thoracis Encountered at the Emergency Department

急診室膿胸成年病患經手術治療之預後因子探討

蔡遠明(Yuan-Ming Tsai) ； 謝志明(Chin-Ming Hsieh) ； 林冠勳(Kuan-Hsun Lin) ； 林雅玲(Ya-Ling Lin) ； 黃敘愷(Hsu-Kai Huang) ； 黃才旺(Tsai-Wang Huang) ； 李世俊(Shih-Chun Lee) ； 張宏(Hung Chang)

《胸腔醫學》 32卷2期 (2017/04) Pp. 64-71

摘要

Introduction: Thoracic empyema is a complicated clinical problem in the emergency department (ED). Patients with empyema thoracis have a high risk of developing sepsis, resulting in substantial morbidity and mortality. However, predictors for empyema thoracis in ED adult patients have not been identified, and whether the thoracoscopic approach is effective for ED patients with empyema or complicated pleural effusion has not been fully investigated. The objective of the study was to investigate possible signs and the prognosis of ED adult patients with thoracic empyema undergoing thoracoscopic surgery, as well as to identify risk factors for mortality. Methods: We retrospectively reviewed the clinical characteristics and treatment outcomes of patients diagnosed with empyema thoracis in the ED between 2007 and 2011. The prognostic values of age, sex, comorbidities, clinical presentations, and stage were assessed. Univariate analysis was performed, followed by multivariable modeling to determine significant risk factors for postoperative mortality. Results: Records of a total of 161 patients were analyzed. Eleven patients died postoperatively. We divided the patients into survivors and non-survivors. Univariate analysis showed statistically significant differences in the stage of thoracic empyema (odds ratio, 9.14; 95% confidence interval, 2.21-37.86; p=0.002). Multivariate analysis revealed that female sex and stage III empyema independently predicted postoperative mortality. Conclusion: Women with empyema thoracis in the ED had higher postoperative mortality rates after video-assisted thoracoscopic surgery. The other risk factor was stage III empyema. Further study is warranted to determine the cause of these differences and to determine their effect on survival.

關鍵字

emergency ； women ； empyema thoracis ； video-assisted thoracoscopic surgery ； mortality

並列摘要

前言：膿胸病患可能合併敗血症導致併發症及死亡。目前尚無確定預後因子可針對膿胸病患經胸腔鏡手術後進行預測。本研究主要探討急診室膿胸成年病患經手術治療後死亡之可能危險因子。方法：回溯性收集161位經急診室診斷為膿胸住院後接受胸腔鏡手術病患的資料，包括年齡、性別、合併症、臨床表徵、期別等，分析是否有影響術後死亡率之危險因子。結果：161位病患中，男性有119位，女性有42位，術後死亡有11位。單變量分析發現期別和死亡率相關。多變量分析後發現性別，尤指女性及期別和死亡率相關。結論：胸腔鏡手術為有效的治療策略，然而急診膿胸女性病患術後有較高死亡率，另一危險因子為膿胸期別，仍需更多研究來探討相關危險因子的關聯性。

並列關鍵字

急診室 ； 女性 ； 膿胸 ； 胸腔鏡手術 ； 死亡率