Light abscess is considered a bomb that causes damage to the body.
Abscess is a purulent-destructive formation, the development of which can be rapidly or gradual.
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The symptoms of the abscess are manifested in the form of 2 stages.
Before entering the purulent exudate in the bronchus, this period will be accompanied by:
- Increase temperature indicators;
- Feeling chill;
- Increased level sweating;
- Dry cough that will be accompanied painful sensations from the localization of the focus;
- Heavy breathing and even shortness of breath;
- In severe cases, respiratory failure can develop.
Percussively will be observed shortening the sound over the area of \u200b\u200bthe localization of the focus, the auscultative will be brought to hard breathing.
On the formation of an abscess in lung will testify general form Patient, and will be observed:
- Changing the color of the skin, it will become pale;
- The appearance of a cyanotic blush on his face, especially from the defeat;
- The forced position of the patient, more often he will lie on the side on the side of the defeat;
- Reduced arterial pressure, Tachycardia and arrhythmia.
After perforation in the bronchus, a cough will be observed, which is accompanied by the release of a large amount of purulent and unpleasant sputum (up to 500 ml.).
In the event of a good drainage of the abscess cavity, the general condition of the patient will improve. After 1.5-2 months, the pathological manifestations of the abscess will disappear.
If the drainage is insufficient, will be attended:
- Body temperature indicators at the same high level,
- Feeling of chill;
- Sweating;
- Unproductive cough;
- Dyspnea;
- Manifestations of intoxication of the whole organism;
- Lack of appetite;
- Fingers in the form " drum chopsticks"And nails resembling the" glass of the clock ".
If there is a positive variant of the course of the disease, which is accompanied by perforation of the glance in the bronchus, you need to expect speedy recovery. 
If the course of the disease is unfavorable, it will be accompanied by the formation of different complications:
- PIPNEMOTEKS;
- Empiama pleura;
- Bacteramemic shock;
- Sepsis;
- Lonantic bleeding.
Of all the listed complications, bleeding is more often developing. It arises as a result of injury of bronchial arteries.
You can talk about bleeding if there is a cough with blood release, the amount of which exceeds 50 ml.
Lonantic bleeding is accompanied by sprawling sputum with the presence in it impurities of red foamy blood. Cases may occur when blood is excreted from the oral cavity without preliminary cough jolts.
If bleeding is quite intense it will be accompanied by a decrease in blood pressure, the poverty of the skin, the frequent pulse of weak filling. This pathological condition is considered rather dangerous, because it leads to the death of the patient.
Than gangrene lungs differs from abscess
Under the lung abscess It is necessary to understand the disease characterized by the purulent melting of pulmonary tissues, mostly cases with a tendency to eliminate. Gangrene of the lungs is expressed, like an abscess, rotten decay of the lung fabric, but without the presence of a trend towards exciting.
But both pathological conditions are often accompanied by similar characteristics. This is the confirmation of this that there are cases when an abscess is accompanied by changes in a reducing nature without signs of separation.
With lung gangrene, especially when easy form Current, the process of rotten decay can suspend and form a deliberate cavity.
Separate from each other these diseases are not easy and from the point of etiology and pathogenesis. Certain differences can be observed in the clinical symptoms of these pathological conditions, because with gangrene, the sputum has nasty smell (smelly).
Treatment of these diseases is carried out on almost the same scheme, so often the best option is considered to describe these pathological conditions together.
Classification and reasons
In medical practice, it is customary to classify diseases by:
- Reasons for formation. The primary is an abscess, if the cause of its appearance was injured chest. The secondary abscess can be told in the case of severe respiratory diseases.
- Localization in the body. The central abscess is distinguished when the lesion is localized in the center of the lung, and the peripheral, which is located closer to the periphery of the lung.
- Duration of the flow. Basically, the acute course of the disease is distinguished, the duration of which is 1.5 months, after this period, recovery is observed. Chronic, it lasts more than six weeks and is characterized by alternating periods of exacerbation and remission.
- The nature of the disease occurs. Allocate a slight course that will be accompanied by the appearance of cough and shortness of breath, middle severity - Pathological manifestations will be expressed moderately and heavy, which is accompanied by clinical manifestations of high-intensity disease, the risk of complications dangerous to human life appear.
Abscess is considered to be a process, it is infectious and caused by bacteria or mushrooms. Microorganisms penetrate the lung cavity along with blood flow from foci of infections present in the body. 
In most cases, the causes of the formation of abscess are considered:
- Pneumonia;
- The overlap of the lumen of the bronchum is a tumor or a foreign body, which leads to a violation of the patency on it and the development of stagnation of mucus in the lower departments with the addition of an infectious process;
- Getting into the lumen of the respiratory tract of gastric content;
- Sepsis.
The factors that help the development of the disease include:
- Smoking;
- Drinking alcohol;
- General hypothermia;
- Reducing the resistance of the body;
- Chronic respiratory diseases;
- Flu.
Pathogenesis and Development Stages
More often the occurrence of abscess in the body precedes clinical picture focal inflammation of the lungs, accompanied by overwork, the effect of stress, disorders of the functioning of the nervous system.
As a result of the collapse of the parenchyma of the lungs, there is a decrease in local immunity, and this makes it easier to hit the pathogenic microorganisms into pulmonary fabrics.
Abscess is an obstructed pulmonary fabric, which has odds from healthy tissue. In the case of a high level of body resistance, the affected fabrics are isolated from healthy by forming a capsule.
More often, an affectionate is in a light one, but sometimes there are situations in which many purulent cavities are observed. Fabrics located around are also involved in inflammation, it flows with a smaller level of intensity.
If the appearance of an abscess in the tissue of the lung was preceded by its infarction, then the main role will be played circulatory disruption. Over time, the infection process will be attached, it will descend through the bronchial tree.
As a result, we can conclude that various factors play a major role in the pathogenesis of the disease, which other times are joined with time.
Eliminate such basic stages of the disease:
- Infiltration.
- Decay.
- Breakthrough.
- Healing.
But it is taken into account that the presented speaker may vary and complicate, and this will lead to the chronicization of the process.
Video
Acute and chronic disease
Medical workers:
- Gangrenous course of the disease that is formed as a result of hitting the defeat pathogenic flora, bacteria and mushrooms.
- Acute abscess, accompanied by a feeling of pain in the chest of strong intensity, hemoplank, the appearance of shortness of breath and cough with the release of purulent sputum. In the case of perforation of the cavity of the abscess into the lumen of the bronchi, an improvement in the overall condition of the patient will be observed. The process will characterize cough with a large amount of sputum, which will have a rotten smell.
- Chronic abscess is characterized by changing exacerbations and remissions. To exacerbate the disease, all the manifestations of acute abscess will be characteristic. If remission is observed, then the pain in the chest will weaken, but will join the peasant cough, with an increase in the amount of sputum released and increased sweating, especially at night. The characteristic symptom of remission is the fast fatigue of a patient person.
Necessary diagnostic events
Most informative method The diagnosis is considered to conduct radiography.
It can be carried out as in direct and in the side projection.
Will be observed characteristic symptoms:
- Round shadow syndrome;
- Blurring of contours;
- The nature of the content of an ulcer will be homogeneous;
- An increase in lymph nodes in the root from the localization of the lesion process;
- Thick walls that separate the lesion site.
But it is necessary to remember that each stage of the disease has differences on the X-ray. If the snapshot is made on initial stages Diseases, the ability of the abscess will be small, up to 4 cm. Perifocal foci of inflammatory character and the deformation of the pulmonary pattern will be present.
There will also be an increase in the level of fluid, this symptom will be noticeable if conducting a survey in dynamics. Over time, the inner wall of the annular shadow becomes more dense and smooth. 
Abscess in the drainage stage will look like this: there is a thinning of the wall, the center shows enlightenment, the sequesters will be located above the fluid level. The outer part of the capsule becomes blurred due to the purulent inflammatory process.
The abscess that was cleared, testify the sophisticated walls of the capsule, the cavity does not contain liquids. Over time, these walls overgrow with a connective tissue, so a certain time the size of the cyst will not change, a scar is formed.
In the case of a favorable disease, the purulent cavity passes quite easily.
With a favorable course of cyst disease 3 stages:
- Ostly, last 3 months;
- Chronic, which will be present for one and a half;
- False cyst.
Effective treatment of the disease
The faster the disease is revealed and its treatment has begun, the more successful the forecast will be.
Persons with abscess of pulmonary fabric require immediate hospitalization and inpatient treatment. Put inhalation of oxygen and balanced nutrition.
Treatment should consist of destination:
- Drainage to eliminate pus in the lesion focus;
- Preparations that will have a detrimental effect on the pathogenic microflora;
- Means of combating the manifestations of intoxication of the body;
- Funds that ensure improvement of immunity;
- Symptomatic drugs.
In case of ineffectiveness conservative treatment Or, in the case of the presence of testimony, surgical intervention is carried out.
Antibacterial drugs are used in maximum doses. For example, Penicillin is administered intravenously to eight times a day (up to 8-10 units).
Before appointing an antibacterial drug, the microflora sensitivity is determined. For treatment, a combination of several antibacterial drugs and ways to introduce them can be used.
Quite common and effective is considered to carry out the washing of abscesses through the bronchoscope. For this purpose, saline, fragine is used. After such washes into the bronchial tree, proteolytic enzymes, bronchophyters and antibiotics are introduced.
To eliminate the purulent exudate in the lesion, there are also transom-worn punctures. For the same purpose, the postural drainage is used, the essence of which is to provide such a position to the patient, which would contribute and facilitate the debit of sputum.
Aerosol therapy and therapeutic gymnastics are carried out.
Possible complications of the disease
To complications that may be formed as a result of the presence of the lung abscess include:
- The lack of the therapeutic effect on the appointment of antibacterial drugs and the transition of the disease in chronic staging or on the other side;
- Entering purulent content in the pleural cavity with the formation of an empieme of pleura;
- Veins thrombosis and arteries leading to the lungs and from them;
- Formation of bronchopulmonary fistulas;
- Hemochlorin;
- Pulmonary bleeding;
- Clinical recovery that will be accompanied by purification of abscess through bronchus and the formation of air cyst;
- Bacteremia, which leads to the occurrence of toxic shock;
- Diffuse pneumonia, which arises as a result of ingress in Mnu in airways (as a result of abscess perforation);
- Abscess brain, inflammation of brain shells;
- Death.
To prevent the formation of the lung abscess, it is necessary to try to avoid diseases of the respiratory organs, and in the case of their presence, timely and adequate treatment.
Doctors advise:
- Do not overcohe
- Balanced and eat;
- Get rid of bad habits (tobacco and alcohol abuse);
- In the presence of cold illness in time to seek medical care;
- In suspected pneumonia, it is necessary to have a mandatory radiographic study.
Under the action of pathogenic microorganisms on the pulmonary tissue, it is destroyed. So there is an abscess of lightweight and heavier form of infectious destruction - its gangrene. These diseases are accompanied by an derogs of a pulmonary plot and its decay.
Light abscess - formation in the form of cavity, usually rounded shape filled with purulent contents. It is surrounded by a shell consisting of fibers. connective tissue and impregnated with immune cells and blood proteins of the lung plot.
Light abscesses
A much more severe condition is a lung gangrene. It is accompanied by quickly propagating the leaning of the fabric and is not deliberate from healthy areas.
Gangrenoz abscess - an intermediate option between these two states, having a tendency to eliminate from normal tissue.
These diseases arise mainly in male people aged 20 to 55 years. The frequency of the disease over the past decades has decreased significantly, but the mortality rate remains quite high - up to 10%. If the gangrene is caused by a cynical stick, klebsiella or golden staphylococcal, the frequency of adverse outcomes increases to 20%.
Classification
Smoking - Light Abscess Risk Factor
Conditions that increase the risk of abscess or gangrene of the lungs:
- smoking experience;
- diabetes;
- influenza disease;
- alcohol abuse;
- immunodeficiency states;
Infectious destruction of the lung fabric occurs when severe neurological diseases (consequences of stroke, miastic, amyotrophic sclerosis), with long vomiting, epileptic attacks, a foreign one in bronchi. Risk factor is any operation under general anesthesia, as well as the use of narcotic substances. Finally, the penetration of microbes into the lungs contribute to the disease of the stomach, accompanied by the cast of its contents in the esophagus, or, for example.
Development of the disease
Usually microbes fall into the lungs through the upper respiratory tract. Often, their source is in the nasopharynx, for example, with tonsillitis. Very often, microbes are inhaled together with microscopic particles of the contents of the stomach after vomiting or gastroofine reflux. The disease often occurs when injected or injury.
Microorganisms that have fallen in Alveola cause an inflammatory response that is accompanied by enhanced penetration into this section. immune cells blood. Leukocytes actively destroy pathogens, forming enzymes that destroy proteins, and pus. The resulting cavity is surrounded by a dense cellular shaft.
After 15 - 20 days, the abscess is revealed to the nearest bronchus and empty. The cavity falls down, leaving behind the focus of the compacted (sclerized) lung.
Gangrena develops faster. As a result of circulatory disorders of the active action of pathogens, inflammation is not limited, an extensive section of the lungs occurs. There are many disintegrating foci, some of which is emptied through bronchi. In the blood of the gangrene, a large number of toxic exchange products, causing severe intoxication (poisoning) of the body.
Clinical signs
Diseases usually precede. Abscess is formed within 14 days.
Signs of the disease before the emptying of the affection:
- high temperatures with chills and then;
- coughing without sputum;
- increasing respiratory frequency;
- light lips lips, brushes, stop.
After emptying the abscess, which occurs on 4 - 12 day of the disease, appears:
- cough attack with one-time release of purulent sputum volume up to 0.5 l;
- reduced temperature and improvement.
If the abscess cavity is cleaned badly, such symptoms are developing:
- re-increased temperature, chills, sweating;
- difficult compartment of sputum with a milder smell when coughing;
- student breathing;
- lack of appetite, weight loss;
- lethargy headache, nausea;
- thickening nail phalanx; Nails become round and convex.
Gangrena lung is accompanied by similar, but pronounced more pronounced symptoms:
- fever up to 40 ° C and higher;
- stunning chills, strong sweating;
- lack of appetite and weight loss;
- when coughing and breathing - chest pain;
- cash attacks with lots of purulent sputum.
Diagnostics
The disease diagnoses the therapist or a pulmonologist, taking into account the preceding diseases of the conditions, duration and severity of the signs. Since the destruction of lung fabric is often found at pneumonia, the doctor must regularly and carefully carry out percussion and auscultation in order to suspect the disease on time and send the patient to additional diagnostics.
Laboratory signs
Blood test:
- increased number of leukocytes;
- the appearance of rod forms;
- ascending SEE;
- anemia is possible.
Large lung abscess with fluid level
Abscess lungs need to be distinguished from such diseases:
- breath cancer;
- cyst;
- actinomycosis;
- vegener granulomatosis;
- empiama pleura.
Medical events
Therapy is carried out only in the hospital.
Caloric nutrition with high protein content. Fat should be a bit limit. Very useful for patients:
- decoction of rosehip berries;
- boiled liver;
- fruits, vegetables, juices.
Taking salt and fluid need to shorten a little.
Medications
The basis of treatment is. The duration of their reception reaches 2 months. First antibacterial drugs Assign empirically. This is modern inhibitor-protected penicillins, such as amoxicillin and clavulanic acid.
Second row:
- lincomycin + aminoglycosides or cephalosporins;
- fluoroquinolones + metronidazole;
- carbapenes.
After the sensitivity results are obtained, the scheme can be adjusted. Initially, drugs are administered intravenously, then in tablets.
Association is prescribed with intravenous solutions, symptomatic means (antipyretic, vitamins, stuffing).
Abscess can be drained at bronchoscopy, as well as punishing it through the surface of the chest, using ultrasound or radiography to control.
Vibrating massage and postural drainage are appointed.
Operation
Surgical intervention is carried out in 10% of patients. Indications:
- non-efficiency of antibiotics;
- the likelihood of lung cancer;
- the diameter of the basin is more than 60 mm;
- chronic form of abscess or gangrene;
- breakthrough in the cavity of the pleura.
Depending on the size of the pathological focus, the corresponding part of the lung or the entire organ is removed.
Rehabilitation and forecast
After discharge, the patient is observed at the pulmonologist. Control x-ray Assign 3 months after recovery.
Simple respiratory gymnastics
At home it is necessary to carry out respiratory gymnastics. From folk remedies, the effectiveness of honey and bee products can be noted. Inhalations with juice of garlic, eucalyptus essential oils, pines are also useful. It is recommended to use chamomile, lime color, raspberry, rosehip.
After an abscess of lungs, recovery occurs in 60 - 90% of cases. In 15 - 20% of patients are developing chronic abscess. Mortality does not exceed 10%. With severe gangrene, adverse outcomes are registered in more than 40% of cases.
To avoid such a severe disease, prevention is needed to eliminate risk factors. They are listed in the relevant section of our article.
The most frequent complications of acute abscess and gangrenes of the lungs is:
Pulmonary bleeding;
PIPNEMOTORKS (Empiama Plevra);
Sepsis (septicopemia);
The damage to the contralateral lung (due to the bronchogenic propagation of purulent sputum).
Chapter 8. Forecast
The forecast of the disease is determined by:
Mechanism for the development of the disease (aspiration, postpnemonic, embolitical abscess, etc.);
The character of microflora and associated with these pathologists of the lung tissue;
The state of the macroorganism (chronic impudent diseases of the lungs, severe general general diseases, bad habits, the presence of immunodeficiency, etc.);
Features of therapeutic and diagnostic measures (the timeliness of hospitalization in the profile department, early formulation of the diagnosis and the volume of medical measures, etc.);
The presence of complications.
Depending on the above factors, the sharp abscess of the lung takes place:
With a tendency to recovery when under the influence comprehensive treatment Clinical manifestations of the disease are quickly eliminated, the cavity of the gland decreases and the center of the abscess (complete recovery) is formed on the site of the abscess (full recovery), or a dry cavity (recovery with "defect");
The healing of the abscess occurs slowly, the cavity empties from the pus
it is not enough, poorly falling, regeneration processes are slowed down - acute abscess becomes chronic;
In patients with concomitant pathology, with a particularly virulent infection and poor drainage of abscess through bronchus, the disease progresses with the development of complications, the formation of new uphties in the contralateral light (casting sputum) or internal organs (metastatic abscesses), heart activities, kidney impaired, liver function and can lead to the death of the patient.
The favorable course of the lungs are rarely and only with complex intensive therapy (antibiotics, detoxification, bronchial reservation, immune correction, etc.), which subsequently does not exclude the need for operational intervention.
Chapter 9. Differential Diagnosis I
The differential diagnosis of the sharp abscesses of the lung is carried out mainly with malignant neoplasms, tuberculosis, fastened cysts and echinococcus lung.
Absoed with lung cancer is not uncommon. Under the central cancer and complete obstruction of the bronchi, the suppuration is developing in the atelectase zone or obstructive pneumonitis, with peripheral lung cancer - in the center of the neoplasma against the background of necrosis and decay of tumor tissue.
In differential diagnosis, it is necessary to take into account the age of the patient, anamnesis, the difference in the severity of individual clinical symptoms, the dynamics of the disease in the process of conservative treatment conducted.
Methodically competent (at least 5 analyzes) cytological examination of sputum is largely important: a large amount of neutrophilic leukocytes, elastic fibers, bronchial epithelium cells with severe dystrophic changes, non-specific microflora are revealed in abscesses and gangrene of the lungs; For lung cancer, typically detection of tumor cells.
With a radiological study for lung cancer, it is clear
defined lesion area and lack of peripocal inflammatory
changes, the presence of atelectsis (subsegement, segment, lung shares), at the later stages of the RA of the lung cancer, the path of the cancer lymphangoita binding the tumor I appears. with the root, the increase in the roasting lymph nodes is determined;
for abscesses, it is easily characteristic of the pronounced infiltration of pulmonary fabric without clear boundaries, st. Lung root cattura is usually saved. There are also differences in the contour; ; The outer and inner walls of the cavity under cancer and lung abscess: with peri4th cancer, the outer outlines of the shadow shadow are bug, fuzzy places, with the presence of gentle lights going to the pulmonary tissue (Cancer lymphangit, Corona Inaligna), with the abscess of the lung outdoor outlet shadow outfunda (blurred) ; The inner walls of the cavity during the peripheral cancer are uneven, undermined, during abscesses, as a rule, the cavity of the destruction is located in the center of the infiltrate, its inner walls are smooth, clear; In the case of abscess on the aiming tomograms, it is possible to see the abscess of the bronchus draining abscess, with lung cancer, the drainage bronch is not visible.
Computer or magnetic resonance tomography in some cases is crucial, because More clearly reveals both the tumor itself (according to the gradient of the tissue density) and the invasive nature of its growth, as well as the presence of signs of intrathustic lymphsdenopathy.
Endoscopic study in combination with biopsy data (revealing in bioptate of tumor cells) plays a decisive role in central lung cancer;
with a peripheral cancer, the final information can be obtained at the transducer I nkational biopsy - cell detection malignant tumor In the punctual, the diagnosis of cancer.
In recent\u003e, the number of patients with blocked lung abscesses has increased. Under blocker! This lung abscess should be understood the presence of in a light limited zone of non-specific suppuration with a complete or partial disruption of the pavement of the drainage bronchus. In two thirds of patients, the blocked lung abscesses proceed without pronounced clinical manifestations and detected x-ray as a rounded or oval shape of shading with clear, bug-in contours, often on an intact pulmonary background, with localization mainly in the upper lung sections (Fig. 4).
In the diagnosis of blocked abscesses of the lungs, carefully assembled anamnesis with a targeted search for clinical manifestations of the beginning and
diseases of the disease, accounting for the dynamics of laboratory and radiographic data,
"Endoscopic picture in comparison with the effectiveness of conductive treatment.
With blocked abscesses, the presence of destruction can be revealed on tomograms. In the clarification of the diagnosis, selective bronchography is helped - Patognomonic for the lung abscess is filling the abscess cavity by contrast through partially closed bronchus, or through neighboring bronchi. With a negative result of selective bronchography, it is necessary to carry out a transbrochial or transducer biopsy of the formation - the presence of a cytological pattern of non-specific purulent inflammation (neutrophilic leukocytes in the layer of lysis, purulent deriters, macrophages, histiocytes, a glot microflora) and the absence of tumor cells allows the overwhelming majority of patients to eliminate the peripheral lung cancer .
The differential diagnosis of acute lung abscess and infiltrative
pneumonic tuberculosis in the decay phase helps the abstract data (profession, contact with tuberculosis patients), the study of sputum, bronchi washwater, sowing sputum on special environments in order to identify mycobacterium tuberculosis, bronchoscopy with biopsy mucous membrane shell, response intensity to tuberculin (manta test) , enzyme immunoassay (definition of antibodies to mycobacteriums), as well as x-ray examination, especially tomograms of the lungs, on which it is often possible to identify near the cavity of the destruction of fresh tuberculous foci (foci of dropout).
Voaging light cysts flow with a less pronounced clinic, rather than an easy abscess: the cough moderate, the sputum of the mucous-purulent, odorless, the fever rests 2-3 days and, under the influence of antibiotics, quickly disappears. Radiologically joined lung cysts have a characteristic type of "single thin-walled cavities of a rounded or oval shape, with thin walls without peripocal inflammatory infiltration.
It should be remembered that the detection of the syndrome of a curious or spherical education in the lungs in patients over 45-50 years requires primarily the tightness of the lung cancer and the expectant tactics are unacceptable here. When coaching on cancer and the inability to prove this diagnosis of the above-mentioned gtems, diagnostic thoracotomy with urgent histological freaking of operational material (lung tissue, lymph nodes, pleura) is shown, which decisters a diagnosis of a diagnosis and determines the further tactics of the patient's treatment.
Abscess and gangrene is easy as separate nosological forms allocated Renee Theophile Hyacinth Laennek in 1819. Ferdinand Sauerbroh (1920) proposed to unite these diseases under the general name "Light suppuration".
G.I. Sokolsky (1838) in "Teaching about breast diseases, taught in 1837 at the Department of Medical Sciences of the Imperial Moscow University, listeners 3, 4 and 5 courses, led a detailed clinical description of the acute abscess and gangrene of the lung. The first report on the operational treatment of gangrene refers to 1889, when N. G. Freiberg described Pnemotomy, performed by KK Raire.
The solid scientific basis treatment of acute pulmonary suppurations received in the 20th century. In 1924 I.I. The Greeks reported on the 20-year experience of the operational treatment of the lung gangren with the use of Pnemotomy. Supporters of this operation were S. I. Szakokukotsky and A.N. Bakulev. In the second half of the last century in the clinics A.P. Wheel, P.A. Kupriyanova, A.N. Bakuleva, V.I. Strochkov, A.A. Vishnevsky, F.G. Uglova, I.S. Kolesnikova, M.I. Perelman, E.A. Wagner is actively developing radical anatomical resection and pneumonectomy with acute abscess and lung gangrene.
The last 10-15 years, the problem of magnificent lung diseases is rarely discussed in foreign literature, but remains still relevant for our country. With a common destruction of the lungs caused by the association of high-volumentant, poly-resistant microorganisms, the results of treatment remain unsatisfactory and high mortality remains: with an acute abscess of 2.5-4%, limited gangrene (gangrene abscess) - 8-10%, common - 45 -fifty%.
The main features of pathology
The abscess of the lung is a limited granulation shaft and a peripocal infiltration zone, an intimate cavity formed as a result of the collapse of necrotic regions of pulmonary fabric and containing pus.
Gangrena Lekhsky - necrosis of a significant section of lightweight fabric, more often, two pieces or all lungs, without demarcation, which has a tendency to further distribute. The cavity of the destruction during the gangrene is always containing necrotic sequesters.
Etiology and pathogenesis
When implementing any etiological factor of incigepatory lung diseases, sharp pneumonia is developing with well-known clinical manifestations. In most observations, as a result of timely rational therapy, the acute inflammatory process is reversible - infection is suppressed, alveolar exudate is resubruited, inflammatory infiltrate is resolved. Otherwise, under certain conditions and adverse circumstances, necrosis of pulmonary fabric develops, followed by the formation of degradation cavities.
The first information about the pathogenesis of acute abscess and lung gangrenes is given in 1871 L. Traube. They concerned mainly the condition of the bronchial tree in the development of the intra-alert valurating process without taking into account the role of the infectious factor.
The respiratory tract has efficient local and system mechanisms that support the sterility of terminal bronchioles and lung parenchyma. The causative agent contaminates the respiratory tract as a result of inhaling the aerosol of small particles, the aspiration of the orofarengial secret, or hematogenic means.
The aspiration of orofargial content is warned due to cough and doped reflexes. Mechanical delay at the level of the upper sections of the tracheobronchial tree in combination with mukiciliary transport warns the contamination of peripheral respiratory tract. If the infectious agent reaches the alveolar level, cells are activated and gumoral mechanismsdesigned to eliminate pathogenic microorganisms.
With certain states, the mechanisms for the protection of bronchopulmonal structures are damaged and the inflammatory process develops. Alcoholism, drug addiction, epilepsy, cranopy and brain injury, an overdose of sedatives, general anesthesia, a coma of any origin and other states that cause disturbances of any origin and other conditions that cause disturbances are considered to be predisposing for this. It is with them that the respiratory tract is easily contaminated by aggressive microflora rotho-nasopharya.
In the etiopathogenesis of acute pulmonary suppurations, unfortunate anaerobic microorganisms play a leading role. More than 300 species of pathogens of this group are known, capable of causing lung destruction. Bacteroides, Fusobacterium, peptostreptococcus, peptococcus and others are most often allocated from purulent foci, that is, the flora, usually colonizing the nickelgial area.
With an acute abscess and gangrene of light unfortunately, anaerobes are always found in associations with aerobic hospital strains. Most often it is Pseudomonas Aeruginosa, Escherichia Coli, Klebsiella Pneumoniae, Staphylococcus Aureus, etc.
In the pathogenesis of bacterial destruction of the lung great importance It is attached to a violation of the maintenance of bronchial branching with the formation of atelectasis, as well as impaired blood circulation on bronchial and pulmonary vessels with the development of ischemia of bronchopulmonary structures.
Classification
Taking into account the experience of our clinic and on the basis of previously known classifications, we have proposed a classification scheme, and we do not insist on its endlessness, but we believe that in a practical way it is quite convenient.
- Etiology
- Postpnemonic
- Post traumatic
- Aspiration
- Obstructive
- Hematogenic
- Clinical characteristic
- Acute abscess
- single
- multiple (unilateral or double-sided)
- Gangrena lung
- limited (gangrenous abscess)
- Common
- Morphological characteristic
- Collective necrosis - "wet" gangrene
- Coagulative necrosis - "dry" gangrene
- Collecting Coagulation Necrosis - Mixed Type
- Complications
- Empiama pleura
- with bronchiploral post
- without bronchiploral message
- Lonantic bleeding
- Aspiration inflammation of the opposite lung
- Phlegmon thoracic wall
- Pulmonary sepsis
Epidemiology
Statistical data on the prevalence of this pathology is not systematized, not accurate and contradictory. Acute abscess and gangrene of lung develop more often in men (67%) of working age - 45-55 years. Most social patients are not safe, abuse alcohol and tobacco.
Hematogenic (always double-sided) lung abscesses occur during angiogenic sepsis. They suffer from drug addiction 2/3 of these patients. Quite often, the destruction of the lungs are combined with bacterial endocarditis, HIV.
Diagnostics
In general, the clinical picture of acute abscess and gangrenes of the lung is identical, but there are also differences, primarily in the severity of the state of patients, the severity of endogenous intoxication and polyorgan deficiency.
Clinical manifestations of acute abscesses are dependent on stage and period of the disease. Lung destruction does not develop suddenly. It is always preceded by an acute, as a rule, tightened, pneumonia of different etiology.
Absoing the lung significantly worsens the patient's condition. Weakness, indisposition, febrile temperature appears. Later joined the pain in the chest, increasing on the breath, unproductive cough.
As the infection process and an increase in the volume of destruction, the body temperature becomes hectic, its lifts are accompanied by pouring sweats. An unproductive cough is enhanced, which is the character of painful paroxysmal. Inxication increases, respiratory failure.
Listed clinical signs Characteristic for lung abscess, not reported with tracheobrichial wood. If a qualified treatment has not begun at this stage of the disease, the next stage of the disease is a spontaneous breakthrough of the ulotnik to the regional (as a rule, segmental) bronchus.
In the patient, against the background of an ardent cough, suddenly, full of mouth cleaves badly smelling purulent sputum. During the day, after this, the patient's condition is somewhat improved - signs of intoxication, chest pain, shortness of breath decrease, the temperature decreases.
When examining the patient with sharp abscess of light, the pallor of the skin with a grayish tint, cyanoticity of the lips and nail beds is detected. Because of the pain in the chest - the breath of superficial. When percussion can determine the shortening of sound if the affectionant is located in the lung raincoat, with auscultation - the weakening of breathing, dry and wet wheezing.
As a result of intoxication, respiratory failure, pain in the chest, the patient defines tachycardia, hypotension is possible. In general blood test, pronounced leukocytosis is detected, the neutrophilic shift of the formula, an increase in ESP.
Even more manifest manifestations of pulmonary destruction are detected in patients with gangrene lung. The condition is severe or extremely heavy. Pronounced weakness, frequent surface breathing, febrile or hectic temperature, anorexia.
The patient is depleted, the skin is pale with a blue gray tint. Dry skin dry. Forced position - sits, leaning on the elongated hands. The ribs are embedded in soft tissues. The breast wall on the side of the lesion is not involved in breathing, intercostal intervals are narrowed.
The main feature is continuously, the intolerance purulent sprinkle with fibrin, small sequesters of pulmonary tissue in a daily volume from 500.0 to 1500.0 (!) Ml and more (due to multiple bronchial fistulas, through which purulent is drained through which purulent The contents of the pleural cavity - an empieme of pleura).
When percussion - shortening sound over damaged light. Auscultation determines a sharp impact of breathing or its absence on the pathology side. Above the controlled listeners, scattered dry and wet wipes are suspended due to the aspiration of purulent sputum of the painful lung.
In clinical analysis of blood is determined pronounced anemia Hyperstocytosis, a shift of formula to young forms, toxic neutrophil grain, an increase in ESO.
The basic method of confirming the clinical diagnosis of bacterial destruction of the lung remains polyposition x-ray and radiography of the chest, allowing you to confirm the diagnosis and determine the localization of the process. With the acute abscess of the lung to the message of it with the bronchial tree, the correct rounded round of the homogeneously darkened cavity with perifocal infiltration is determined. After emptying the waste into the respiratory tract - the cavity with the level of fluid.
The X-ray pattern of the gangrenous abscess is characterized by the cavity within the lobes of the lung with the joining-like incorrect outline of the internal circuit due to necrotic sequesters of the lung tissue.
For the widespread gangrene of the lung characteristic of the total darkening of hemitoxis on the side of the disease with small irregular outlines by air cavities, hydropneumothorax (Empiama Plevura).
The golden standard of radiation diagnosis of lung diseases should be considered a computer tomography, which allows you to study the structure of extensive education, its localization and to carry out the differential diagnosis of native and other diseases, in particular, cancer and pulmonary tuberculosis.
The list of mandatory instrumental studies of pumping diseases of the lungs includes fibrobronchoscopy, allowing to evaluate the severity and prevalence of endobronchitis, diagnose the foreign body, broncholite or tumor of the bronchus, carry out a fence material for microbiological and cytological studies.
Differentiate the sharp abscess and gangrene of the lung is, first of all, with destructive forms of the tuberculosis process.
Certain difficulties occur with the differential diagnosis of acute abscesses and peripheral lung cancer with the decay (strip shape of the tumor). Often, the suppuration with the formation of intramilia cavities is developing in patients with central cancer of segmental, equity or chief bronchi. This occurs as a result of infection of the atelectasted areas of lung tissue (obstructive pneumonite), the natural evacuation of the contents of which becomes impossible due to tumor obturation.
Aspergillem and echinococcus of light and other diseases with clinical radiographic syndrome of acute impudent should be included in the differential series.
Anamnesis, clinical manifestations and data of modern radiation diagnostic methods underlie differential diagnosis in lung diseases, but the final diagnosis is established on the basis of the study of the results of microbiological, cytological and histological research.
The material for the study is taken from the tracheobronchial tree (fibrobronchoscopy), with a transcutane puncture of pathological formations of light and pleura under the control of computed tomography or ultrasound.
Empiama pleura - The most typical complication of sharp bacterial destruction of the lung. It develops as a result of a breakthrough of intra-alerts in a pleural cavity. As a rule, the empieme cavity is reported through the center of degradation with the tracheobrichial tree (bronchoploral fistulas), which causes the formation of a popenemotrax with a collapse of the lung.
Empiama pleura impairs the condition of the patient by increasing the resorption of toxins, the deterioration of gas exchange in the disabered zones of the light-saving light and displacement of the mediastinum into a healthy side.
With acute empy, the patient feels a sharp pain in the chest. Dyspnea enhances, cyanosis appears. With auscultation on the side of the damage, the breathing is not auditioned or strongly weakened. Percussively determines the tympanite over the upper hemitox departments and shortening the sound in the basal departments.
On sightseeing radiographs (straight and lateral projection), a pattern of hydropneumability with a horizontal level of liquid and a lung collapse is found.
Treatment
Treatment of acute bacterial destruction of the lung - unconditional prerogative of surgeons. top scores Reached under the conditions of specialized thoracic departments. The severity of the patient's condition implies a variety of intensive therapy, parachururgical procedures and emergency operational interventions in case of complications.
Conservative and Parachirurgical Treatment
Conservative treatment includes infusion environments and medicationscapable of correcting homoseostasis disorders, developing as a result of long-term intoxication, hypoxemia and anorexia. Methods of efferent therapy and gravitational surgery are used, provided that the unts are adequately drained.
When the patient arrives with the acute bacterial destruction of the lungs in the surgical hospital is immediately appointed empirical antibacterial therapybased on data on polyimicrobial etiology of pleurpulmonal infection. Subsequently, prescribed correction is carried out, taking into account the results of the microbiological research of the contents of uluses.
In the treatment of acute abscesses and gangremen, combined (2 or more drugs) is often used, antibacterial therapy is often used. Examples of such combinations can be:
- cephalosporin 3 generations + aminoglycoside (amikacin) + metronidazole;
- aminoglycoside (amikacin) + clindamycin;
- fluoroquinolone 3-4 generations + metronidazole;
- tigatil.
However, monotherapy is possible using cefoperazone / sulbactam or carbopenmes. In the acute period of disease, antibiotics are prescribed mainly intravenously. An indispensable condition for antibacterial therapy is the prevention of systemic methods with anti-grain agents (diphlokan, microsist, flukosanol, etc.).
The leading role in the pathogenesis of bacterial destruction of the lung plays a violation of bronchial patency. To restore the bronchial drainage it is necessary to use a variety of methods sanitation of tracheobronchial wood.
Simple and enough effective reception Emptying purulent cavity is postural drainage. To implement it, the patient is given a position in which an affectionant is higher than the draining bronchus. For example, when localizing an abscess in 2 or 6th easy segments (Rear segments), the patient is stacked on the stomach with a slightly lowered head end of the bed, which creates conditions for the natural outflow of infected contents in the respiratory tract with its subsequent active refuse. Drainage is advisable to combine with vibration massage of the chest.
This method is not enough effective if the thick purulent sputum, the sequesters of the pulmonary tissue block the drainage bronch. In these situations, it is advisable to apply the selective sanitation of the pathological focus using the catheter, which is transcutically introduced into the trachea.
Under local anesthesiaCompletely painlessly, the puncture of the pistevenous-thyroid ligament (FOSSA Canina) is performed, through the needle in the trachea according to the CELDINGER type technique, an X-ray-contrast, specially modeled catheter, the tip of which under the control of the electronofactor converter or the fibrobronchoscope is mounted in a drainage bronchine or purulent cavity. A pavement is carried out through the catheter (12-14 drops in 1 minute) of the pathological zone with solutions of room temperature with the addition of antiseptics, antibiotics and prolonged proteolytic enzymes.
In patients with large and giant sublished ulcers containing deriters, fibrin, the sequesters of the pulmonary fabric it is advisable to combine intrabrochelial rehabilitation with percutaneous drainage of the infected cavity, which suggested A. Monaldi (1938) for the treatment of tuberculous cavities.
The breakthrough of the gland to the pleural cavity implies additional parachururgical procedures.
Some methods of treatment of empya are known since the hypocratic times. Following its principle "UBI PUS IBI EVACUA" a great doctor pierced the chest patient with a hot iron rod or a knife and introduced bronze tubes into the pleural cavity, removing the pus.
Similarly, they are currently being received using modern devices and tools. With a total empieve, the pleura is installed two drainage: in the second intercostriety in the middle clavical and seventh - on the rear axial lines. The content of the pleural cavity is evacuated by vacuuming.
With an empieme of pleura with bronchiploral messages, active aspiration is not enough effective - easy to straighten. In addition, developing syndrome of the breakdown due to abundant air dodging from the respiratory tract, hypoxemia is enhanced.
In this case, it is advisable to carry out the selective occlusion of the foul-carrier bronchi polyurethane foam (foam). The occluder is carried out through a rigid bronchoscope tuber and is established under the control of the vision at the mouth of the segmental or share bronchus, draining an affectionant. The bronchiploral message is terminated, the rescussion of the lung occurs due to the disgracement of "healthy" segments.
A special place in the treatment of acute impudent diseases of the lung occupies lonantic bleeding - Complication that most often ends with the death of the patient. Patients with massive pulmonary bleeding are dying as a result of flooding with the blood of the respiratory tract (the volume of the tracheobronchial tree is 80-120 cm3) and asphyxia.
The first task in massive pulmonary bleeding is to stop the flow of blood into "healthy" tracheobronchial wood departments. For this, the rigid tracheobronchoscopy is urgently performed, the side of bleeding is determined and, if possible, the share or segmental localization of the source is determined. After the obturation of the main or share bronchus, the respiratory tract is exempt from the spectacular blood.
The second task is to detect a bleeding vessel and perform endovascular occlusion. As a rule, it can be done in patients with acute light abscess, where, when performing selective angiography, a bronchial artery hyperplasia is found with pronounced hypervascularization of the pathological zone, extravasia of contrasted blood.
If the x-ray-plating occlusion of the bronchial arteries was successful, then repeated bronchoscopy is carried out, an occluder is removed, a thorough rehabilitation of the tracheobronchial tree is performed and the conservative treatment of the underlying disease continues. Otherwise, emergency surgical intervention is appointed.
It is more difficult to develop a situation in patients with gangrene lung, since the source of massive, as a rule of pulmonary-pleural, bleeding is the branches of the pulmonary artery and the inflows of the pulmonary veins. The possibility of endovascular surgery in these cases is limited. In rare cases, it is possible to stop bleeding the implantation in the lung artery branch of Hanitric Spirals.
Surgery
Purposeful conservative and parachirurgical treatment in most of the patients with acute lung abscess (95-97%) avoids an emergency operation. The indication for surgical interference with the pathology under consideration is continuing bleeding.
Approximately 3-5% of observations, the acute abscess of the lung does not end with recovery and illness takes a chronic nature with typical remissions and exacerbations. It is definitely judged about the timing of the transformation of acute abscess into chronic difficult, however, it is believed that the acute abscess not cured for 2 months should be attributed to the group of chronic pulmonary suppurations that require active surgical treatment.
On the contrary, with a common gangrene of a light alternative to an emergency operation, since conservative and parachururgical treatment ends with the death of the absolute majority of patients. In patients with limited gangrene (gangrenous abscess), it is possible to use a gentle, organ-powdering operation by type of pneumotomy or thoracopleabscessosomy.
The operation lies in the projection limited thoracotomy through the beds resected 1-3 ribs in the zone closest to the pathological process. Pump and sequesters of pulmonary fabric are removed. The edges of the parietal pleura and leather are stitched by forming a pleuroabscessum for the subsequent long-lasting open sanitation of the purulent cavity.
The disadvantage of this operation consider the greater probability of the development of the phlegmon of the chest wall, osteomyelitis of ribs, arrosive bleeding. In addition, limited gangrene lung meets infrequently, in contrast to the common process, when surgery through limited access is impossible.
Therefore, despite the very difficult condition of the patients, it is necessary to carry out a radical operation, as a rule, in the amount of anatomical pneumonectomy. These operations are accompanied by severe complications and high mortality, but there is no other way to solve the problem.
To prevent the flock of purulent sputum into the opposite light (the patient is on the operating table in the position on a healthy side) on the eve of the operation, endoscopic occlusion of the main bronchum on the lesion side is carried out. Along with this, the bronchial intubation is performed, for example, carlene tube.
Access - advanced thoracotomy in the fifth intercole. From the pleural cavity is removed by pus, fibrin sequesters of pulmonary fabric. Pulmonary artery, upper and lower pulmonary veins are consistently processed. The most careful, without extensive skeleton, the main armor is allocated, is stitched by the device, it cuts off. Light removed. The bronchi cult is additionally stitched by monophilic atraumatic threads 3/0, whenever possible is pleasing.
The pleural cavity is carefully sanited, drainage are installed, lay layer seams are superimposed on the wound. Remote lung is a non-structural necrotic parenchyma and nude segmental bronchi, arteries and veins (which is why Gangrena lung is often complicated by profuse of pulmonary-pleural bleeding).
The most frequent complication postoperative period With anatomical resection of the lung, the failure of the cult of bronchi (50-70%). The main reasons for its occurrence are the pronounced inflammatory process in the bronchi wall (panberrychit), common aerobic anaerobic empya pleura. It is also important that the reparative processes in patients with gangrene lung depressed as a result of coarse disorders of homeostasis, secondary immunodeficiency.
The failure of the Bronchi culture is diagnosed on the basis of a significant air intake on pleural drainage during coughing and forced breathing, increasing respiratory failure. Confirmed fibrobronchoscopy.
For the treatment of arising complication, retologotomy is performed, the rebellion of the cult of bronchi with re-imposition of seams. Relationship of insolvency occurs in 92-95% of observations. If it is possible to stabilize the patient's condition, to suppress the acute infectious process in the pleural cavity, then bronchoploral fistula is formed, chronic emmps of pleura.
Analysis of pathogenesis of pulmonary destruction suggests that this problem is not only not so much medical, but rather a socio-medical. Therefore, an important stage in the prevention of the emergence of perplexed diseases is the improvement of living conditions, sanitary education and population dispensarization, timely diagnosis and treatment on early stages Complete-friendly pneumonia, the immediate direction of the patient into a specialized department in the event of a pulmonary-pleural complication.
Light abscess They call a disease characterized by the formation of a cavity with pus in the pulmonary tissue, delivered from the intact sections with a pyrogen capsule that is generated during the development of inflammation. Gangrena lung It is characterized by necrosis of a large massif of the pulmonary 쇴 Kani. In the absence of the degradation of the destructive process from unaffected parts of the lung inflammatory granulation shaft and the progression of necrosis with its distribution to all the easy disease is indicated as common gangrene. If the process is delivered by inflammatory granulation shaft, then this limited gangrene (gangrenoz abscess). Abscess and gangrene of the lung are the most frequent sharp magnificent lung diseases. They refer to the group of non-specific destruction of the lung and are characterized by necrosis of the pulmonary parenchyma with its disintegration, melting the dead lightweight fabric to form in this cavity zone.
Classification infectious lung destruction
· by the nature of the pathological process:
1. Acute purulent abscess;
2. Acute gangrenous abscess;
3. Completed lung gangrene;
4. Chronic abscess.
· in gravity of clinical flow:
light, moderate gravity, heavy.
· by the nature of the flow:
1. Not complicated;
2. Complicated (epipherable pleura, pulmonary bleeding, sepsis, pneumonia of the opposite lung, etc.).
In addition, lung abscesses can be single and multiple, unilateral and double sided.
Etiology and pathogenesis.
In the pathogenesis of sharp suppuration of the lungs, 3 factors play a leading role:
1. Violation of bronchial patency;
2. Acute infectious process in the pulmonary parenchyma;
3. Violation of blood supply to the plot of pulmonary fabric caused by its necrosis.
The processes in the pulmonary tissue are schematically developed as follows:
· The starting mechanism is a violation of bronchial patency;
· The atelectases of the pulmonary tissue, draining the blurred bronchus (alveoli and bronchiols of this section are filled with liquid);
· In the conditions of airless pulmonary fabric, the activities of the pathogenic microbial flora can lead to circulatory disorder, tissue necrosis and pulmonary suppuration.
The origin of acute impudent lung diseases:
1. Postpnemonic lung abscesses (formed within 3-4 weeks);
2. Aspiration abscesses of the lungs (formed within 1-2 weeks);
3. Traumatic;
4. Hematogenic-embolistic;
5. Lymphogenic.
Complaints.
Clinical current acute abscess Light is usually clearly divided into two periods: 1) The period of formation of a purulent cavity to a breakthrough in bronchus, and 2) the period after the breakthrough of the gland to the drainage bronch. First period Acute purulent abscess is characterized by acute principle with an increase in body temperature up to 38 or more degrees, chest pains and cough - dry or with a slight amount of sputum. There are phenomena of pronounced general intoxication, and complaints are associated with it - for general weakness, malaise, sweating, a breaking, deterioration of appetite, headaches.
Second period It is characterized by a breakthrough in the lumen of the bronchi, which is accompanied by the appearance of unpleasant smell of the mouth and a large amount of purulent sputum (200 ml and more per day), a decrease in temperature to a subfebrile, a decrease in the manifestations of general intoxication and the improvement of the overall state of the patient.
With gangrene or gangrenoz abscess The lung clinical picture of the disease is characterized by a heavy state of the patient. The first place is pronounced intoxication until the development of septic shock, respiratory failure is developing. Complaints appear on sharp weakness, the absence of appetite, thirst, painful cough with a slicer sputum of brown, gray-brown, which is divided into three layers after settling: the bottom is a crumb-shaped sediment, the medium is liquid, the upper - mucous-purulent, foamy. Sometimes the stencil smell with breathing is so pronounced that the stay of those surrounding next to the patient becomes impossible. The flow of lung gangrens is often complicated by the hemoplange, pulmonary bleeding, the epipherable of pleura, popurnothorax, which significantly aghesives the patient's condition.
Survey of the patient. The data of the physical examination in the first period is scarce: on the background of fever, the impact of breathing is determined in the damage zone, single-caliber dry and wet wheels. The first period usually lasts 7-10 days, and the listed symptoms are mistakenly treated as manifestations acute pneumonia. The ineffectiveness of the treatment of therapy should be forced to suspect the presence of lung abscess. After the abscess breakthrough into the drainage bronch, there is a decrease in temperature, multiple solid-caliber wet rasions are listened above the affected light. For gangremen and gangrenous abscess of lungs are characterized by lethargy, adynamicity of the patient. Skin Covers Dry, grayish color. Lips and nail beds are cyanotic. The affected side of the chest fell behind in the act of breathing. Fisical data depend on the volume of the necrosis of the pulmonary tissue and the severity of its decay is to dull the percussion sound, the box shade over the cavity of the degradation, located superficially. With auscultation - a significant weakening or lack of respiratory noise, an amphoric shade over a cavity draining through the bronchi, solid-caliber wet wets.
Diagnostics.
1. General analysis Blood reveals an increase in the number of leukocytes with the leukocyte formula shift to the left. With a lung gangrene, a sharp leukocytosis is observed (more than 30,000), the acceleration of ESP is more than 70 mm / h, changes in the leukocyte blood formula with the predominance of young forms, a pronounced toxic neutrophil graininess, significant anemia.
2. Biochemical blood test. Typical hypoproteinemia, disproteinemia, impaired water-electrolyte balance, sharp metabolic acidosis.
3. Bacteriological research Wet and pus with the definition of microflora and its sensitivity to antibiotics, as well as the study of sputum for the presence of tuberculosis sticks, fungal flora.
Tools:
1. Radiological studies of the chest (x-ray, radiography, tomography, cT scan) The first clinical period identifies massive infiltration of lung tissue, mainly within 1-2 segments or lungs. In the second period, the x-ray study makes it possible to detect the cavity of destruction with a horizontal level of fluid against the background of decreasing infiltration of lung tissue, which confirms the diagnosis of lung abscess. With a lung gangrene in the initial phases, radiologically determines the massive drain infiltration of lung tissue within the share of or light. In progression of decay against the background of the infiltration of pulmonary fabric, multiple cavities of destruction of various sizes and the degree of completion of the content are determined. When tomography of lungs are determined by fabric sequesters incorrect formlocated freely or invite in the largest cavities of destruction.
2. Bronchoscopy makes it possible to exclude the tumor nature of the process, carry out the material for bacteriological and cytological research.
Treatment.
Treatment of acute lung abscess goes 3 main directions:
1. The most complete and constant drainage of purulent foci of the lung;
2. Therapeutic effect on the microbial flora of the foci of suppuration;
3. Stimulation of the protective forces of the body.
For adequate drainage of purulent foci in lightly use:
· Postural drainage (giving the body of a patient optimal position for the free removal of pus into draining armor "Self-");
· Chest massage, vibrator massage, breathing exercises;
· Inhalation with soda, bronchoditics;
· Expectorant inside;
· Bronchoscopic reservation of bronchi;
· Intraheal drug infusion;
· Catheterization of segmental bronchi, draining abscess, percutaneous puncture of the front wall of the trachea.
Antibacterial therapy should be carried out with regard to the nature of microflora and its sensitivity to antibiotics. In the absence of these data, a combination is used antibacterial agents:
· Cefalosporins of the 3rd generation +
· Aminoglycosides (amikacin or gentamicin) +
· Metronidazole.
Monotherapy is also possible by the imipenem (thiona) or merronic.
To stimulate the protective forces of the body use:
· High-caloric, rich in protein and vitamins nutrition;
· Antistaphococcal gamma globulin;
· Transfusion of the hyperimmune plasma;
· Albumin, protein, amino acid infusions;
· Disinfecting therapy (fluid infusions, forced diuresis);
Surgical treatment of acute lung abscess is performed in the ineffectiveness of conservative treatment and is as follows:
Drainage of the abscess cavity using a trocar or a thick needle tube (preferably two-section);
Easy resection (most often - 1 share, lobectomy). Indications: Massive pulmonary bleeding, ineffectiveness of conservative treatment, abscess\u003e 6 cm in diameter, pipopurnum.
Treatment of lung gangremen only surgical كا E. After stabilizing the state of the patient with the help of conservative therapy within 7 - 10 days (if there is no pulmonary bleeding or rapid progression of the disease), an extensive resection of the dead part of the lung or the whole lung is performed.
