肺炎后的肺:我们应该为谁做手术?
Daniel Lichtenstein1, Vadim Smolyakov2, Yael Refaely3
1Department of Thoracic Surgery, Kaplan Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Rehovot, Israel.
Journal of laparoendoscopic & advanced surgical techniques. Part A
|February 1, 2024
概括
年轻患者患有与肺炎相关的 empyema 往往需要手术. 手术干预改善了长期的生存率,无论年龄如何,并且与CT扫描上的液体密度等因素有关.
科学领域:
- 胸部外科手术 胸部外科手术
- 肺部病理学 肺部病理学
- 医疗成像医学成像
背景情况:
- 肺炎后的肺是常见的临床挑战.
- 很大一部分患者需要手术干预才能有效治疗.
- 确定手术干预的预测因素对于优化患者护理至关重要.
研究的目的:
- 为了确定与肺炎继发的empyema患者手术干预的需要相关的预测因素.
- 评估手术干预对长期生存的影响.
- 探索放射学发现与手术的要求之间的相关性.
主要方法:
- 对2010-2019年医疗记录的回顾性分析.
- 包括194名被诊断为肺炎的二次肺患者.
- 分类为手术 (A组) 和非手术 (B组) 治疗组.
- 收集临床,实验室和胸部计算机断层扫描 (CT) 数据.
主要成果:
- 年轻的年龄,较高的缩血压和升高的白血球数量是手术干预的重要预测因素.
- 多变量分析证实年龄较小是手术干预的重要因素 (aOR=0.971,P=.023).
- 手术干预与延长生存时间相关 (aHR=1.762,P=.046),而年龄较大与延长生存时间减少相关 (aHR=0.050,P<.001).
- 在手术组中,CT扫描上观察到较高的empyema流体密度 (4.3 HU更高,P<.067).
结论:
- 较年轻的年龄与肺炎相关的empyema手术干预的可能性更高有关.
- 手术干预与改善的长期存活率有关,独立于患者的年龄.
- 放射性特征,如瘤液密度,膜加厚和局部可能预测需要手术.
相关概念视频
01:30Pneumonia III: Complications and Assessment
225
Pneumonia poses the potential for numerous complications that warrant consideration. These complications include the following:
225
01:28Pleural Effusion II: Symptoms and Management
176
Pleural Effusion Overview
A pleural effusion is the abnormal collection of fluid between the parietal and visceral pleura layers of tissue that form the lining of the lungs and chest cavity. It can occur independently or due to surrounding parenchymal diseases, such as infection, malignancy, or inflammatory conditions.
Clinical Manifestations:
A pleural effusion is the abnormal collection of fluid between the parietal and visceral pleura layers of tissue that form the lining of the lungs and chest cavity. It can occur independently or due to surrounding parenchymal diseases, such as infection, malignancy, or inflammatory conditions.
Clinical Manifestations:
176
01:27Pneumothorax-II
150
Pneumothorax is a medical condition defined by the buildup of air in the pleural space between the lungs and the chest wall. This accumulation of air can lead to partial or complete lung collapse, resulting in a range of clinical manifestations. Understanding the clinical presentation and effective management strategies is crucial for healthcare professionals in providing timely and appropriate care to individuals with pneumothorax.
Clinical Manifestations:
Clinical Manifestations:
150
01:29Pneumonia II: Pathophysiology
274
The pathophysiology of pneumonia involves the following steps:
274
01:30Pneumonia I: Introduction
239
Pneumonia is an acute respiratory infection that targets the lungs, specifically the alveoli. These tiny air sacs, essential for oxygen exchange, become engorged with pus and fluid, severely hindering breathing, decreasing oxygen absorption, and causing significant pain and discomfort during respiration.
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
239
01:28Pneumonia IV: Management
329
The treatment of pneumonia varies based on its severity and the causative pathogen. Here is a structured approach to managing pneumonia, integrating pharmaceutical and supportive care strategies.
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
329