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由于肺炎旁积液和脓胸的临床表现具有多样性,因此无论在治疗上还是诊断上它们的处理都是临床的难题。胸膜腔感染的临床表现可以从少量的、无并发症、不需特殊处理的单纯胸腔积液,到多房分隔的胸腔积液或脓胸;重者可以伴有胸膜纤维化、肺萎陷、脓毒血症、呼吸衰竭以及远处感染。长久以来,人们一直认为成功治疗胸膜腔感染的关键是胸膜腔脓液引流,但最近临床上开始应用一些新技术,如:图像引导下微导管置入技术、胸膜腔内滴注纤溶剂以及内科胸腔镜技术。针对这些新的诊治方法,目前已有一些诊治指南出台,但仍存在一些疑问,其中最受关注的问题是纤溶剂的使用。
Due to the diversity of clinical manifestations of pneumonia and empyema, both their treatment and diagnosis are clinically problematic. The clinical manifestations of pleural infection can be from a small amount, without complications, without special treatment of pleural effusion, pleural effusion to separate the pleural cavity or empyema; severe cases can be associated with pleural fibrosis, lung collapse, Sepsis, respiratory failure and distant infections. It has long been believed that the key to successful treatment of pleural infection is pleural pus drainage, but recently started to apply some new technologies, such as: image-guided micro-catheter implantation, intrapleural infusion of fibrinolysis and internal medicine Thoracoscopic technique. For these new treatment methods, there are already some guidelines for the introduction of treatment, but there are still some questions, the most concern is the use of fiber solvent.