- 期刊
Empyema of the Thorax in Infants and Children
小兒膿胸症
摘要
三軍總醫院小兒部自民國59年至70年間共經歷了47例膿胸症之病兒，年齡從20天，到13歲，其中63.8%年齡小於2歲，男與女之比例爲24:23，好發之月份爲每年二至七月，83%發生於60至66年間，臨床上之特徵爲高燒、咳嗽、呼吸窘迫。病發前徵，支氣管肺炎34例佔72.3%，未痊癒之肺炎4例佔8.5%，麻疹後引起之肺炎2例佔4.25%，其餘膿皮症、骨髓炎、魚刺引起之喉頭後膿瘍、腹瀉各1例各佔2.1%。發病之初83%的病例的白血球數超過10,000/mm^3，70%的病例的中性白血球超過10,000/mm^3，12.8%病例有貧血（Hgb小於9gm%）的現象。症狀出現至發現膿胸的時間平均約爲8.5天。 放射線檢查顯示左側膿胸佔46.8%，右側膿胸佔44.6%，兩側膿胸佔8.5%。肋腔蓄膿細菌學研究顯示葡萄球菌19例佔47.5%，革蘭氏陰性菌（包括Pseudomonas aeruginosa, Proteus vulgaris, N. catarrhalis, A. aerogenes, E. coli）佔17.5%，培養無菌者佔32.5%。敏感性試驗顯示89.5% Staphylococcus aureus對盤尼西林具有抗藥性，而全部均對Prostaphlin有感受性。 治療使用合併抗生素，胸液穿刺術，胸管引流者佔75%。合併胸管引流及胸膜切除術者佔19%。病兒接受胸管引流手術後，平均10.8天發燒消退。共有4例死亡，病例死亡率8.5%。
關鍵字
無資料並列摘要
Forty-seven cases of empyema if the thorax were diagnosed in infants and children over an eleven-year period of 1970-1981 at the Tri-Service General Hospital, giving an overall rate of 4 per 1,000 of the total pediatric admissions. Their ages ranged from 20 days to 13 years, 63.8% of them were below 2 years of age. Most cases had precipitating infections such as bronchopneumonia and measles pneumonia. A few cases were associated with sepsis, osteomyelitis and retropharyngeal abscess. The clinical manifestations included high fever, cough, dyspnea and cyanosis. Auscultation revealed decreased breath sounds on the affected side. From chest X-ray findings, there were 21 cases with left side empyema, 19 cases with right side, and 3 patients with bilateral involvement. A few cases had pyopneumothorax collapse of the lung, encapsulated lesion or pneumatocele. Staphytococcus aureus (47.5%) was the pathogen most frequently isolated from pleural fluid. Gram negative organisms (Pseudomonas aeruginosa, Aerobacter aerogenes, Proteus vulgaris, etc) were the next most common pathogens isolated. Sensitivity tests showed that 89.5% of S. aureus were resistant to penicillin, and all were sensitive to prostaphlin. For most cases, the managements included thoracocentesis with adequate antibiotics and closed chest tube underwater drainage. Decortication was indicated in a few patients. The overall case mortality rate was 8.5% (4/47 cases).