Principles of treatment. Chronic purulent diseases of the lungs The main symptoms of purulent diseases of the lungs

(abscess and gangrene of the lung, bronchiectasis, purulent pleurisy)

The concept of "acute suppuration of the lungs" includes two forms of damage to the lung parenchyma: acute abscess and gangrene.

Currently, against the background of a significant increase in various purulent-septic diseases, the frequency of acute suppuration of the lungs has also increased, which occur mainly in men of the most able-bodied age. The reasons for this increase are: a decrease in the effectiveness of conventional antibiotic therapy, the emergence of resistant forms of microorganisms, changes in the clinical course of the disease, difficulties in timely diagnosis and choice of treatment tactics (V. T. Egiazaryan, 1975; P. M. Kuzyuklvich, 1978; V. I. Struchkov, 1980; G. L. Nekrich, 1982).

The number of deaths in acute suppuration of the lungs ranges from 2% to 17% of the total number of deaths from various causes. Mortality in complicated forms of destructive lung processes can reach 54% (Yearbook of World Health Statistics, WHO, 1976). Some patients have residual changes in the lungs after treatment in the form of dry residual cavities, bronchiectasis, pneumosclerosis (V. I. Struchkov, 1976). In a third of patients, there is a transition from an acute process to a chronic one, and in 11.7% - a relapse of the disease (G. D. Sotnikova, 1970).

Generally accepted in acute lung abscesses is conservative treatment tactics, but its immediate and long-term results do not always satisfy clinicians. In recent years, in the complex of therapeutic measures, the methods of "minor surgery" have been used: transthoracic drainage, microtracheostomy, bronchoscopic sanitation, etc. (MI Perelman, 1979). These methods improve the results of treatment, reduce the number of complications, and shorten the duration of treatment.

Classification of suppurative diseases of the lungs and pleura

The most complete is the classification proposed by P. A. Kupriyanov for purulent lung diseases.

I. Abscess and gangrene of the lungs:

1) purulent abscesses:

a) sharp

b) chronic - single and multiple;

2) gangrenous abscesses;

3) gangrene.

II. Pneumosclerosis after lung abscesses.

III. Bronchiectasis:

1) in combination with lung atelectasis (atelectatic bronchiectasis, atelectatic lung);

2) without lung atelectasis.

IV. Suppurated lung cysts:

1) single cysts;

2) multiple cysts ("cystic lung").

Classification of purulent diseases of the pleura

I. Acute purulent pleurisy (acute pleural empyema).

II. Pyopneumothorax.

Acute pleural empyema and pyopneumothorax, in turn, can be divided into several groups for various reasons:

1. By pathogen:

a) streptococcal;

b) staphylococcal;

c) diplococcal;

d) mixed, etc.

2. According to the location of the pus:

a) one-sided, two-sided.

b) free, total, - medium, - small;

c) encysted: multi-chamber, single-chamber, apical, interlobar, basal, paramediastinal, etc.

3. According to the pathological picture:

a) purulent;

b) putrid;

c) purulent putrefactive.

4. According to the severity of the course:

a) lungs;

b) moderate;

c) heavy;

d) septic.

III. Chronic purulent pleurisy (chronic pleural empyema).

In addition to anamnesis and objective examination, additional examination methods are of great importance in the diagnosis of lung diseases:

1) multiaxial radiography and fluoroscopy - allows you to determine not only the nature of the process, but also its localization;

2) tomography - allows you to determine the structure of the process, the contents of the cavities, the patency of large bronchi;

3) bacteriological examination of sputum - allows you to determine the nature of the microflora and its sensitivity to antibiotics;

4) the study of the function of external respiration - allows you to determine not only the magnitude of its violation, but also due to which component (pulmonary or bronchial);

5) bronchoscopy - allows you to determine the patency of the bronchi, their contents and its nature, catheterization of peripheral formations is possible;

6) bronchography - allows you to determine the nature of the lesion of the bronchial tree, its localization and prevalence;

7) diagnostic puncture of cavities in the lung - allows you to determine the presence of contents in the cavity, its nature and the possibility of taking it for bacteriological and cytological examination.

Etiology and pathogenesis

Currently, staphylococcus and its associations with other microbes are recognized as the main microflora in acute suppuration of the lungs.

Most often, acute pulmonary suppurations develop as complications of acute and influenzal pneumonia, since they cause damage to small bronchi, which leads to a violation of their patency and the occurrence of atelectasis, creating favorable conditions for the development of the microflora present there. The bronchogenic route of infection with impaired bronchial patency is considered as the main factor in the development of acute suppuration of the lungs.

Most authors believe that acute abscess and gangrene have different morphological changes: with an abscess, inflammation proceeds as a limited purulent fusion, and with gangrene there are no clear boundaries of necrosis of the lung tissue, which tends to spread indefinitely. Such differentiation is necessary because of the difference in treatment tactics: with an abscess - complex conservative treatment, with gangrene - a radical operation.

lung abscess

Lung abscess (abscess, apostema, abscess) is a non-specific purulent disintegration of a portion of the lung tissue, accompanied by the formation of a cavity filled with pus and delimited from the surrounding tissues by a pyogenic capsule. More often, the causative agents of the abscess are pyogenic cocci, anaerobic microorganisms of the non-clostridial type, and others. Often there is a combination of certain anaerobic and aerobic microorganisms. More often, a pyogenic infection enters the lung parenchyma through the airways and much less often - hematogenously. Direct infection of the lung tissue is possible with penetrating injuries. As a casuistry, there is a spread of a purulent process into the lung from neighboring organs and tissues, as well as lymphogenously. It should be noted that the penetration of pathogenic microflora into the lung tissue does not always lead to the occurrence of a lung abscess. This requires a situation accompanied by a violation of the drainage function of the lung area. Most often this occurs with aspiration or microaspiration of mucus, saliva, gastric contents, foreign bodies. Aspiration, as a rule, is noted with impaired consciousness due to intoxication, an epileptic seizure, a traumatic brain injury, and also during anesthesia. Aspiration sometimes occurs with dysphagia of various origins. After aspiration, atelectasis of the lung area occurs, and then an infectious-necrotic process occurs in it. An indirect confirmation of the aspiration mechanism of the occurrence of lung abscesses is a more frequent lesion of the posterior segments of the right lung. Disturbances in the drainage function of the lungs are present in chronic non-specific lung diseases: chronic bronchitis, emphysema, bronchial asthma, etc. Therefore, in certain situations, these diseases contribute to the occurrence of lung abscesses. Influenza and diabetes mellitus predispose to lung abscess. Thus, due to acute obstruction of the draining bronchus, an inflammatory process (pneumonia) occurs, and then the collapse of a portion of the lung tissue. With sepsis, metastatic ulcers in the lungs are noted. Severe bruises, hematomas and damage to the lung tissue can also be complicated by the occurrence of abscesses in certain situations. Therefore, the causes of lung abscesses are diverse. However, when they occur, the interaction of three factors is noted: an acute inflammatory process in the lung parenchyma, a violation of bronchial patency and blood supply to the lung area, followed by the development of necrosis. Each of these factors can be decisive in certain situations.

Classification of acute lung abscesses

The modern rational classification of acute lung abscesses is of great practical importance, as it makes it possible not only to correctly assess the form and severity of the disease, but also determines the appropriate treatment tactics.

Based on clinical and radiological signs, 4 forms of acute lung abscesses can be distinguished:

1) a single abscess (a single cavity with or without a fluid level, surrounded by a zone of perifocal infiltration of the lung tissue);

2) multiple abscesses (several isolated cavities with clear contours with or without fluid level, surrounded by perifocal infiltration of the lung tissue);

3) destructive pneumonia (diffuse infiltration of the lung tissue with multiple small cavities of destruction without clear contours and, as a rule, not containing fluid);

4) acute abscess with pleural complications: a) pyopneumothorax total and limited. With total - the corresponding lung is to some extent pressed against the root, in the pleural cavity there is a liquid with a horizontal level, above which there is air; with limited - liquid and air are in the department of the pleural cavity limited by the adhesive process; b) pleural empyema is total and limited. Total - complete darkening of the corresponding half of the chest due to a large amount of fluid (pus) in the pleural cavity without air or with a small amount of air above the liquid level; limited empyema can be located in different parts of the pleural cavity, but more often adjoins the area of ​​the destructive process.

Approximately half of the patients have solitary abscesses, of which 15-20% are gangrenous. Pathological changes in gangrenous abscess are characterized by significant areas of dead lung tissue in the absence of a pronounced granulation shaft and the presence of high intoxication of the patient, the release of a large amount of fetid purulent sputum. The abscess has an uneven inner surface, the cavity contains pus. The unevenness of the internal contours indicates the presence of non-rejected necrotic areas of the lung tissue, often pulmonary sequesters are determined radiologically.

According to the size of acute lung abscesses, it is advisable to divide into 3 groups:

a) the diameter of the abscess does not exceed 6 cm (the most common type), when it is difficult to use transthoracic drainage methods;

b) the diameter of the abscess reaches 10 cm, when it is possible to use both transthoracic and endobronchial methods of drainage and sanitation;

c) giant abscesses, the diameter of which exceeds 10 cm (in most cases, gangrenous).

Right-sided localization of abscesses occurs 2 times more often than left-sided. Bilateral processes are observed in no more than 5 - 7% of cases. The most commonly affected posterior segments are 2, 6 and 10.

In relation to the cavity to the visceral pleura, single abscesses are usually divided into "peripheral" and "central". With peripheral abscesses, the walls of the cavity are close to the visceral pleura, such abscesses tend to break into the pleural cavity. They can be relatively easily penetrated with a puncture needle or trocar. Central abscesses are somewhat less common. They are not always located exactly in the center of the segment or lobe, but are distant from the visceral pleura by a significant layer of lung tissue, transthoracic access to them is difficult and dangerous for the development of complications.

Multiple abscesses and destructive pneumonia are mostly lobar, but can sometimes involve two lobes, the whole lung, or both lungs.

In addition to pleural complications, hemoptysis and bleeding are often observed. With hemoptysis, blood is released with sputum no more than 50 ml once or in the form of pink sputum and streaks with prolonged discharge. With bleeding, clear blood is coughed up with clots of more than 50 ml once. Depending on the flow, abscesses are divided into blocked and draining.

Clinic of acute suppuration of the lungs

The clinical picture of acute abscesses and gangrene of the lung is determined by many factors, the most important of which are the nature, dose and virulence of the infection, the phase of the process, the state of the body's defenses. The disease is most often observed in men aged 20-50 years, the right lung is more often affected, mainly in the upper lobe.

Clinical manifestations in acute abscess are determined by the phase of its development. The period of abscess formation is characterized by purulent infiltration and melting of the lung tissue, but there is still no communication between the cavity and the bronchial lumen. In this phase, the clinic is similar to severe pneumonia. The course of a lung abscess is characterized by a general severe condition, pain occurs in the affected side of the chest, aggravated by inhalation, breathing becomes frequent, superficial, shortness of breath increases to 40-60 per minute, the wings of the nose fluctuate during breathing. The face is pale, quickly becomes haggard, there are bright pink spots on the cheeks, the lips are cyanotic, there are herpes on the lips.

Percussion reveals a dullness of the pulmonary sound, covering a tense share, voice trembling is increased. When listening, voiced small crepitant rales are noted with an admixture of gentle pleural friction noise. Then bronchial breathing appears, rales increase, respiratory noises weaken, wet rales appear. As a result of softening of the infiltrate, disturbances of the cardiovascular system are significant, tachycardia progresses, heart sounds are muffled, systolic murmur appears at the apex, and blood pressure decreases. The picture of severe intoxication is manifested by sharply fluctuating hectic temperature with amazing chills and sweats, the patient's exhaustion progresses. When examining blood, anemia, high leukocytosis with a shift of the leukocyte formula to the left increases.

An x-ray examination shows a limited shadow of varying intensity and size in one or another zone of the lung field.

All the described phenomena increase within 4-10 days, then usually the abscess breaks into the bronchus, after which the second phase of the course of an acute abscess begins, characterized by a cough with the release of a large amount of fetid, putrid or purulent sputum with a large number of leukocytes, detritus, bacteria, elastic fibers . Sputum when settling is three-layered: the lower layer is made of pus and melted tissues, the middle one is a yellowish liquid, the upper one is made of a foamy liquid. Pulmonary symptoms also change - after opening in the bronchus, abdominal symptoms appear at the site of the former dullness, wheezing appears when the infiltrate softens, and when the pleura is irritated, pleural friction noise appears. When an abscess is opened in the pleura, vivid symptoms of empyema appear: dullness, decreased voice trembling.

A breakthrough of an abscess into the bronchus or pleura will give characteristic symptoms, but more often pulmonary suppurations are manifested by the formation of multiple small abscesses, in which percussion and auscultation are so uncharacteristic that they do not give grounds for an accurate diagnosis.

X-ray examination is of decisive importance: multi-axial transillumination, images in at least 2 planes, which allow you to establish not only the location and size of the abscess and perifocal reaction, but also the distance from the chest wall.

A closed abscess gives a darkening with blurred edges, an open abscess communicating with the bronchus gives a picture of a cavity with a horizontal fluid level fluctuating when the patient changes position, air above the fluid.

According to the clinical course, acute suppuration of the lungs is divided into 3 groups:

1) with a mild course - a satisfactory condition, a small amount of purulent sputum, subfebrile temperature. X-ray - a small single abscess;

2) with the course of moderate severity - a state of moderate severity, shortness of breath, signs of purulent intoxication, radiographically - destruction of the lung tissue within the lobe;

3) with a severe course - the condition is severe, in some it is extremely severe. Shortness of breath at rest, high temperature, severe intoxication, abrupt changes in laboratory tests. X-ray significant changes in the lungs, often bilateral, gangrenous.

In the diagnosis of lung abscesses, radiography and lung tomography are used. Computed tomography and ultrasound are also used.

Treatment

Conservative treatment of acute lung abscess includes three mandatory components: optimal drainage of the purulent cavity and its sanitation, antibiotic therapy, restorative treatment and measures aimed at restoring disturbed homeostasis.

All patients, depending on the severity of the course of the disease, are prescribed an appropriate diet. With a mild course, patients receive table No. 15, with moderate and severe cases - table No. 11. Isolation of purulent sputum with a high protein content leads to the development of hypoproteinemia. Therefore, in addition to a high-calorie, protein diet in patients with a large amount of purulent sputum, a common purulent process requires the use of parenteral protein nutrition (native and dry plasma, amino blood, aminopeptide, casein hydrolyzate, albumin, etc.). In addition, it is necessary to prescribe courses of vitamins of group B and vitamin C, cardiac glycosides.

For detoxification purposes, hemodez, an antiseptic solution are widely used. Good effect gives intravenous administration of 5 - 10% glucose solutions of 300 - 500 ml with 4 - 12 units of insulin.

A powerful anti-inflammatory agent is calcium chloride, when administered intravenously. Usually used 1% solution of 200 ml 3 to 4 times a week, in severe patients daily.

A universal remedy that enhances the body's immunobiological defenses and is used to combat intoxication and anemia is blood transfusion. Blood transfusion should be used mainly in severe patients, in patients with a sluggish purulent process, with hemoptysis under the control of a blood test. Blood transfusion can be performed 2-3 times a week for 200-400 ml.

In recent years, much attention has been paid to immunotherapy, which, in combination with other measures, can increase the effectiveness of the treatment of acute lung abscesses. Due to the fact that staphylococcal infection plays a leading role in the genesis of an acute abscess, immunization is carried out with specific immunopreparations: for passive immunization - antistaphylococcal plasma, antistaphylococcal serum gamma globulin; for active - staphylococcal toxoid.

A certain role in the treatment of acute lung abscesses belongs to methods that contribute to the constant release of the abscess cavity and the bronchial tree from purulent contents. This is the use of steam inhalation with chamomile, sage, soda, expectorants, postural drainage.

One of the measures aimed at increasing the chemical effect is the use of antibiotics. Antibiotics can not be prescribed to patients with solitary abscesses with adequate drainage and sanitation of the cavity, except for gangrenous abscesses. Be sure to use antibiotics in all patients with multiple abscesses, destructive pneumonia and pleural complications, since it is not possible to achieve sufficiently effective drainage and sanitation, especially in the early days. The main route of administration of antibiotics should be intravenous. Preference is given to targeted antibiotics.

Local treatment

The lack of effect from conventional conservative treatment most often depends on insufficient emptying of the abscess cavity from purulent contents through the draining bronchi. Therefore, to evacuate the contents of the abscess and restore bronchial patency, it is necessary to use various methods of drainage and sanitation:

1) transthoracic (puncture, drainage);

2) endobronchial (bronchoscopy, microtracheostomy);

3) a combination of transthoracic and endobronchial methods;

4) a combination of transthoracic drainage methods with temporary bronchial occlusion.

Puncture of an abscess of the pleural cavity.

This method deserves attention as the easiest way to evacuate the contents and introduce drugs directly into the cavity of the abscess or pleura.

Puncture technique: during fluoroscopy on the patient's chest, a point for puncture is outlined, coinciding with the place of maximum approach of the cavity to the chest. The puncture is performed under local anesthesia with a 0.5% novocaine solution in the patient's sitting position. The reference point for finding the needle in the cavity is the feeling of "falling through" and the appearance of pus with air in the syringe during aspiration. The contents of the cavity are completely removed and it is washed with antiseptic solutions (furacillin, furagin). At the end of the puncture, targeted antibiotics and proteolytic enzymes are administered.

The puncture is also used for diagnostic purposes: to resolve the issue of the possibility of transthoracic drainage, if a cavity form of cancer is suspected. As an independent method of treatment, puncture is indicated for peripheral abscesses up to 6 cm in diameter with rapid positive dynamics of the process, restoration of bronchial patency, with limited pleural empyema with a rapid decrease in the size and contents of the cavity.

Contraindications to puncture are: hemoptysis, the central location of the abscess, as well as when the cavity is located in the II segment and the axillary subsegment, since transthoracic access to them is difficult.

Drainage of the abscess of the pleural cavity.

Microdrainage. The advantage of this method is the ability to carry out permanent sanitation of cavities without resorting to repeated punctures.

Drainage technique (Seldinger technique): the most convenient for insertion into the cavity and its sanitation is a subclavian catheter with an internal diameter of 1.4 km. After determining the projection of the cavity, it is punctured with a thick needle, through which a conductor from the catheter set is inserted into the cavity. The needle is removed. The catheter is cut according to the length of that part of the needle that was in the chest (the cut must be made perpendicular to the long axis of the catheter). The catheter is passed through the conductor into the cavity. The guidewire is removed and a stopper is put on the cannula. The catheter is fixed to the skin with a ligature.

Indications for microdrainage are: small and medium-sized abscesses (6-10 cm) with insufficient function of the draining bronchus and a tendency to protracted flow, except for cavities located in segments 1 and 2; multiple cavities up to 6 cm in diameter with fluid levels (each abscess is catheterized separately); limited empyema of the pleura with a slow decrease in size and content; limited pyopneumothorax with a small bronchial fistula.

Contraindications to microdrainage are the same as for puncture.

Macrodrainage. The purpose of the method is the constant evacuation of the contents from the cavity, which contributes to the acceleration of the rejection of necrotic masses and the restoration of bronchial patency.

Drainage technique: it is advisable to use polyvinyl chloride pipes with a diameter of 0.4 - 0.6 cm. After determining the drainage point, which coincides with the place of the closest fit of the cavity to the chest wall and with the level of fluid in it, a control puncture is performed. Upon receipt of the contents of the abscess, the needle is removed. In the puncture area, a small incision is made in the skin and superficial fascia, through which a trocar of the required diameter is passed. After removing the trocar mandrel, a drainage tube is inserted through the cannula into the cavity, on which 1–2 lateral holes are made in advance at a distance of 1.5–2 cm from the end. The trocar is removed, the drainage tube is fixed to the skin with a ligature. Immediately after drainage, the cavity is sanitized, which is then repeated daily. In the ward, the drainage must be connected to a two-jar system that uses cups from the Bobrov apparatus. It can be used as a passive system with spontaneous outflow of contents in a wide bronchial fistula, and a system with active aspiration in the absence or small bronchial communication.

The main indications for macrodrainage are: single, peripherally located, acute abscesses with a diameter of 10 cm or more with a radiographically determined fluid level, including gangrenous ones; multiple abscesses with a diameter of more than 6 cm with fluid levels; total pyopneumothorax and total pleural empyema; limited pyopneumothorax with severe bronchial fistula.

Drainage is contraindicated in hemoptysis, central abscesses and abscesses located in the 2nd segment and axillary subsegment, except for gangrenous ones.

Bronchoscopy.

Sanitation of the bronchial tree through a bronchoscope is currently a generally accepted method of treatment and preoperative preparation of patients with suppurative lung diseases.

Sanitation technique: sanitation of the bronchial tree should begin with the most complete removal of purulent contents with a metal catheter connected to a vacuum pump. After evacuation of pus, 20-40 ml of a warm antiseptic solution (preferably furagin) is injected into the bronchial tree. After 2-3 breaths, against the background of mechanical ventilation, the contents of the bronchi are aspirated. If necessary, washing can be repeated. With viscous sputum, it is better to use a mixture of antiseptic solutions and 2-4% soda in a 1: 1 ratio. At the end of bronchoscopy, antibiotics and bronchodilators are administered.

Bronchoscopic sanitation is indicated for all forms of acute abscess, including those with pleural complications, accompanied by the release of a large amount of purulent sputum, pronounced purulent endobronchitis: with hemoptysis - to localize the source of bleeding and introduce homeostatics into the bronchial tree.

Contraindications for the production of bronchoscopy are: decompensation of vital organs (heart, liver, kidneys); hypertension II - III degree with a tendency to crises; acute myocardial infarction; acute inflammatory diseases of the pharynx, larynx.

Microtracheostomy.

This method of sanitation in the lung, systematically carry out therapeutic manipulations, is quite traumatic, allows you to actively influence the inflammatory focus, causing negative emotions in the patient.

Microtracheostomy technique: It is best to use the same catheter as for transthoracic microdrainage. If the catheter is inserted only into the trachea (with a bilateral process, the patient is in a serious condition), then the manipulation is performed under local anesthesia: The patient lies on his back, a roller is placed under his shoulders. In the region of the notch of the sternum (2-3 cm below the cricoid cartilage), local anesthesia of the skin and soft tissues of the neck is performed with a 0.5% solution of novocaine. After that, a thick needle or a trocar of the appropriate diameter is inserted percutaneously into the trachea. This causes a cough. The needle or trocar is deployed along the trachea and a catheter or conductor is inserted into it (using the Seldinger technique). The catheter is advanced 5-6 cm deep. The needle is removed. The catheter is fixed to the skin with a ligature. When setting up a microtracheostomy under local anesthesia, care must be taken not to damage the posterior wall of the trachea.

In the production of microtracheostomy during subanesthetic bronchoscopy, damage to the posterior wall of the trachea is excluded, since the cutout of the tube is brought to the puncture site, and the needle rests against the beak of the tube when it enters the trachea. In addition, it is possible to introduce a catheter into the draining bronchus or directly into the abscess cavity.

Sanitation through microtracheostomy is carried out as follows: 1-2 times a day, the bronchial tree is washed with a jet injection of a warm antiseptic solution of 10-20 ml. The procedure is performed with the patient in a sitting position. Jet injection of the solution leads to abundant sputum discharge. The introduction of the solution can be repeated 2-3 times during one procedure. In the intervals between jet lavage of the bronchial tree, it is advisable to apply drip lavage 2-3 times for 5-10 minutes. at a rate of 10 - 20 drops per minute. in the position of the patient lying on the side of the lesion. This not only stimulates coughing, but also contributes to better washing of the cavity and bronchi. At the end of the procedure, the patient turns over on a healthy side, which leads to a good emptying of the cavity.

Microtracheostomy is indicated in the following cases: a single, centrally located abscess (regardless of size); single abscess with a diameter of 3 - 6 cm of any localization; solitary abscess located in segment 2 and axillary subsegment (area inconvenient for transthoracic drainage); multiple abscesses of small diameter (3 - 4 cm); destructive pneumonia; any form of acute abscess, accompanied by the release of a large amount of purulent sputum.

A contraindication to microtracheostomy is hemoptysis.

In some cases, the use of one method of drainage and sanitation of the cavity of the abscess or pleura does not provide maximum removal of purulent contents from the cavity and restoration of bronchial patency. In addition, in the course of treatment, one method of drainage and sanitation often exhausts its capabilities and there are indications for the use of another. In these cases, it is advisable to use a combination of local treatments simultaneously or sequentially.

Contraindications to combined drainage are the same as for each of the applied methods.

With transthoracic drainage of giant gangrenous abscesses and pyopneumothorax with wide bronchial and bronchopleural fistulas, complications such as respiratory failure can develop due to the discharge of inhaled air to the bronchial tree through fistulas into the drainage tube and severe subcutaneous emphysema. In addition, with a wide bronchial communication, there are no conditions for reducing and eliminating the abscess cavity and expanding the lung. To eliminate the bronchial fistula and create tightness of the bronchoalveolar system, temporary bronchial occlusion is used in combination with adequate transthoracic drainage of an abscess or pneumothorax with active aspiration.

Technique of temporary occlusion of the bronchus: manipulation is performed during subanesthetic bronchoscopy. As an obturator, you can use a large-porous foam sponge, stitched with a II-shaped seam in the transverse direction. When tying a seam, the sponge acquires a compact, cylindrical shape. This obturator is impregnated with 30% sub-lipol. A balloon catheter for temporary bronchial occlusion has some advantages. The obturator is introduced into the blocked bronchus through a bronchoscope using biopsy cutters, a balloon catheter is inserted through a microtracheostomy under bronchoscope control.

The localization of the bronchus subject to occlusion is specified by the location of the abscess in the lung during X-ray examination, with pyopneumothorax - using search obturation with simultaneous constant air aspiration through transthoracic drainage.

The duration of bronchus occlusion with positive dynamics of the process is 15-18 days.

Contraindications to the placement of a bronchus obturator: insufficiently effective transthoracic drainage of an abscess or pleural cavity, as well as general contraindications to subanesthetic bronchoscopy.

Surgical treatment

Surgical intervention in the acute period should be used according to strict indications: with an abscess complicated by pulmonary bleeding that is not amenable to conservative measures; with progressive abscesses; when it is impossible to exclude a malignant tumor with abscess formation.

The volume of surgical intervention depends on the prevalence of the process. The operation must be radical, therefore, as a rule, lobar resections and removal of the lung are performed.

The criterion for the transition of an acute abscess to a chronic one is the absence of positive dynamics within 8–10 weeks of intensive treatment or 3 months after the onset of the disease. Clinical signs of the transition will be: stabilization of the clinical picture with persistent manifestations of pulmonary suppuration and radiological changes.

Conservative treatment of chronic abscess in the absence of contraindications to surgical treatment is, as a rule, preoperative preparation. It includes: detoxification, protein preparations, antibiotic therapy depending on the sensitivity of the microflora, sanitation of the abscess cavity, exercise therapy, chest massage, postural drainage.

Surgical treatment is indicated for the transition of an acute abscess to a chronic one, frequent exacerbations of the process, hemoptysis. Radical operations are performed - lobectomy, bilobectomy, pulmonectomy.

Control questions

1. Causes of lung abscesses.
   1. Classification of abscesses.
   2. Features of the clinical course of abscesses.
   3. What are draining and blocked lung abscesses?
   4. Principles of conservative treatment of abscesses.
   5. Types of drainage of lung abscesses. Indications and contraindications.
   6. Tactics of treatment depending on the location of the abscess and its size.
   7. Outcomes of lung abscesses.
   8. Working capacity of patients after treatment.

Bronchiectasis

Bronchiectasis (bronchiectasis) is a disease characterized, as a rule, by a localized chronic suppurative process in dilated, deformed, irreversibly altered and functionally defective bronchi. The independence of bronchiectasis, as a separate nosological form, has been disputed to date, since bronchial dilatation can occur in a variety of pathological processes, accompanied by long-term inflammation and fibrosis in the bronchopulmonary tissue. Bronchiectasis that occurs as a complication or as a manifestation of another disease is called secondary. According to many researchers, congenital cases should be attributed to bronchiectasis.

The reasons for the development of bronchiectasis have not been fully elucidated. A significant role in their formation is played by the genetic inferiority of the bronchial tree. At the same time, the congenital "weakness" of the bronchial wall (insufficient development of smooth muscles, elastic, cartilaginous tissue, etc.) is of some importance. In case of violations of the patency of the bronchi (subsegmental, segmental or lobar), their drainage function is disturbed with a delay in secretion, which leads to the formation of atelectasis of the corresponding section of the lung.

Depending on the form of bronchial expansion, there are: cylindrical, saccular, fusiform, mixed and communication bronchiectasis. Some researchers distinguish congenital bronchiectasis (bronchiectasis), atelectasis and bronchiectasis not associated with atelectasis. According to the prevalence of the process, one- and two-sided bronchiectasis are distinguished. This takes into account the localization of changes in lobes or segments (left-sided lower lobe, reed segments, middle lobe, etc.). According to the clinical course and severity of the condition, four forms are distinguished: mild, moderate (severe), severe and complicated. It is necessary to indicate the phase of exacerbation or remission.

When examining a patient with bronchiectasis, the following objective data attract attention: pallor, puffiness of the face, symptoms of "drum sticks" and "watch glasses", visible deformity of the chest.

The main common symptoms for all patients are:

1. Cough - the main symptom of chronic suppuration, is different both in nature and intensity. A superficial cough is noted in the initial phases of the development of the disease, paroxysmal cough is deep, especially in the morning. The cause of the cough is the destruction of the lung tissue with an effect on the nerve endings.

2. Purulent sputum is weakly expressed in the initial phases, subsequently, during destruction with a cough, from 100 ml to 2 liters of sputum is separated, in 90% it has a fetid odor.

3. Hemoptysis and pulmonary bleeding were observed in 70% of patients, especially when the case is neglected.

4. Pain in the chest is associated with the transition of the inflammatory process to the pleura.

5. Fever is an indicator of the degree of purulent intoxication.

6. A change in the shape of the chest and a violation of the symmetry of its participation in the act of breathing manifests itself in the form of retraction of the chest, retraction of the intercostal spaces, convergence of the ribs.

The symptomatology revealed by percussion and auscultation is various. Percussion determines different options for muffling percussion sound under the affected area. Auscultatory - hard or bronchial breathing and moist rales of various calibers. Since the development of the abscess - all signs of a cavity, including amphoric breathing.

Simultaneously with the clinical manifestations of impaired gas exchange in the lung, other systems are also disturbed as a result of hypoxia and intoxication: cardiovascular - with a drop in blood pressure, an increase in central venous pressure, and expansion of the capillary network.

The antitoxic function of the liver decreases, in the kidneys the phenomenon of focal nephritis.

Changes in the hemogram are determined by anemia and progressive leukocytosis.

X-ray examination reveals different intensity of darkening in the area of ​​the focus and the zone of perifocal inflammation. Pronounced saccular bronchiectasis is characterized by ring-shaped shadows or enlightenment in the affected lobe of the lung. The disadvantages of the X-ray method are compensated by special studies, such as tomography, bronchography.

With bronchography in the affected area, one or another form of bronchial expansion of the 4-6th order is detected. There is also a convergence of the bronchi and non-filling with a contrast agent of the branches located peripherally to bronchiectasis. Sometimes the bronchi of the affected lobe are easily compared with a bunch of twigs or a chopped broom (a tree without leaves). Bronchoscopy is of great importance for rehabilitation, assessment of the severity of the suppurative process, the prevalence of endobronchitis and control over the dynamics of the process. Most often, bronchiectasis is localized in the lower lobe and reed segments of the left lung. Somewhat less often they are found in the middle lobe and basal segments of the right lung.

In the clinic of bronchiectasis, three periods of the development of the disease are distinguished:

1. In the first, early period, bronchiectasis is asymptomatic, the only sign may be hemoptysis.

2. In the second - pronounced bronchiectasis - period, there are periodically exacerbations of the inflammatory process in the bronchi and lung tissue.

3. In the third, late period of the disease, the disease is characterized by chronic intoxication and increasing pulmonary heart failure.

Treatment of patients with bronchiectasis is carried out mainly in the 2nd and 3rd periods of the disease. With infrequent exacerbations, in the stationary course of the process, conservative treatment is carried out: good nutrition, stimulating and vitamin therapy, positional drainage - postural drainage, bronchoscopic sanitation with the introduction of antibiotics, inhalations with bronchodilators and antibiotics. Antispasmodic drugs. With the progression of the disease after appropriate preparation, a radical operation is indicated: lobectomy, pulmonectomy. In the third period, in the presence of pronounced changes in the lungs and other organs, only palliative operations are possible - ligation of the pulmonary artery, less often - pneumotomy.

With localized bronchiectasis, removal of the affected part of the lung (segmental, lobectomy, or bilobectomy) usually gives good immediate and long-term results. Mortality during these operations is practically reduced to zero. With bilateral local bronchiectasis, the tactics of surgical treatment are different. The first stage is an operation on one lung, and after 6-8 months - on the other. There are also single-stage operations. In these cases, a longitudinal sternotomy is performed and the affected sections of both lungs are removed. Unpromising are lung resections in patients even with local bronchiectasis, accompanied by total bilateral obstructive bronchitis and persistent pulmonary heart failure.

In the postoperative period, such patients should be actively managed: early rising - prevention of pneumonia, a course of sanitation bronchoscopy, blood transfusion and protein preparations.

Control questions

1. What is bronchiectasis?
   1. Clinical manifestations of bronchiectasis depending on the stage of the disease.
   2. Features of conservative therapy for this disease.
   3. Indications for surgical treatment.
   4. Types of surgical interventions.
   5. Rehabilitation of patients and examination of working capacity.

Pleural empyema

Empyema is an accumulation of pus in a natural (anatomical) cavity, whether it be the pleural cavity or any other cavity. Therefore, the accumulation of pus in the pleural cavity is called pleural empyema. There is another term - purulent pleurisy. Purulent pleurisy is an inflammation of the pleural sheets, accompanied by sweating of purulent exudate into the pleural cavity. Therefore, the terms "purulent pleurisy" and "empyema of the pleura" are synonymous, although sometimes doctors of various specialties confuse these conditions to this day.

Primary empyema can be mainly with penetrating wounds of the chest and after operations on the organs of the chest cavity.

In the development of acute pleural empyema, purulent destructive processes in the lung and, first of all, acute abscesses, which, when they break into the pleural cavity, lead to a purulent process in the pleura, play the greatest role. Pleuropneumonia, croupous pneumonia are often complicated by purulent pleurisy as a result of infection entering the pleural cavity along the lymphatic tract or along the length.

Pleural empyema can also develop with suppuration of various lung cysts, decaying lung cancer.

Trauma, a penetrating wound of the chest, accompanied by hemopneumothorax, is often complicated by purulent pleurisy of traumatic origin.

Pleural empyema is observed in purulent processes of the abdominal cavity, retroperitoneal space, which is associated with a large number of lymphatic anastomoses between them and the chest cavity. Metastatic empyemas of the pleura are described in sepsis, phlegmon, osteomyelitis.

Classification of pleural empyema

1. According to the clinical course: purulent-resorptive fever and purulent-resorptive exhaustion.
   1. By appearance: empyema without lung tissue destruction; with destruction of lung tissue.
   2. By pathogenesis: metho- and parapneumonic, post-traumatic, metastatic and sympathetic.
   3. By length: limited, widespread, total.
   4. The degree of compression of the lung: I, II, III.
   5. Acute and chronic.

According to this classification, empyema is limited if only one wall of the pleural cavity is involved in the purulent process. When two or more walls of the pleural cavity are affected, the empyema is designated widespread. Total empyema is called, in which the entire pleural cavity is affected from the diaphragm to the dome. Those cases are assigned to the I degree when the lung is compressed within the anatomical boundaries of the cloak, i.e. by 1/3. II degree means that the lung is compressed within the trunk, i.e. by 2/3. At the III degree, the lung is compressed within the nucleus (complete collapse of the lung).

A feature of the clinical picture of acute pleural empyema is that its symptoms are superimposed on the clinic of the primary disease that caused the empyema. The disease usually begins with severe stabbing pains in the corresponding half of the chest, aggravated by breathing and coughing. In the future, with an increase in the amount of exudate, pain may decrease slightly. The appearance of dry cough, subfebrile temperature is noted. Growing intoxication, respiratory failure. Pyopneumothorax is characterized by a sudden development of the clinical picture as a result of air and pus entering the pleural cavity during abscess rupture. The pain syndrome, pulmonary insufficiency, up to a state of shock sharply increases.

On examination, it is determined: the diseased half of the chest is slightly enlarged, the intercostal spaces are expanded, it lags behind when breathing. It also determines the weakening of voice trembling. With percussion, dullness is noted, increasing downward.

X-ray examination is of great importance for clarifying the diagnosis, which allows to clarify the presence of air and fluid in the pleural cavity, determine its level, the nature of the pathological process in the lung, and the degree of mediastinal displacement. Dynamic X-ray observation of both the sick and the healthy side is especially important. From the side of clinical and biochemical analyzes, the changes are the same as in other purulent processes.

The classic radiological sign of pleural empyema is the presence of an oblique Damuazo-Sokolov-Ellis line. There may be a total and subtotal accumulation of fluid with a shift of the mediastinum to the healthy side. In some cases, a limited (encapsulated) liquid is determined. Sometimes an X-ray examination is performed in lateroposition (on the side). Computed tomography and ultrasound are also used.

To clarify the diagnosis, a trial pleural puncture is of decisive importance, which allows to establish the presence of fluid and air in the pleural cavity, to suggest the nature of the exudate, to examine it bacteriologically with the determination of the sensitivity of the microflora to antibiotics. In addition, during the puncture, pleurography can be performed, which makes it possible to accurately determine the size and shape of the empyema. Recently, thoracoscopy has become widespread, which allows not only to determine the severity of changes in the pleural sheets, the presence of adhesions, the size and localization of bronchial fistulas, but also to biopsy the pleura and thoroughly sanitize the pleural cavity.

Acute pleural empyema must be differentiated from a festering cyst, lung abscess, subdiaphragmatic abscess, cancer, lung atelectasis, lower lobe pneumonia.

Treatment of acute pleural empyema should be combined with the treatment of the primary disease.

The main treatment tactics is a complex conservative therapy using local methods of sanitation of the pleural cavity.

Conservative therapy should include the following activities:

High-calorie protein nutrition, table - 11;

transfusion of protein preparations;

Detoxification therapy;

Anti-inflammatory and antibacterial treatment;

Immunotherapy (both passive and active), including single-group blood transfusion 2-3 times a week.

Local treatment includes:

Puncture of the pleura;

Drainage of the pleural cavity.

The purpose of these methods is to evacuate the contents and sanitize the pleural cavity, which helps to accelerate the rejection of necrotic masses and cleanse the pleura. With bronchial fistulas of small diameter or their absence, the use of active aspiration leads to a rapid expansion of the lung and the elimination of purulent inflammation.

In the acute period, surgical treatment is usually not used. It is used only with the failure of conservative therapy, the transition of empyema to the chronic stage, the combination of suppuration with bronchial fistulas and destruction of lung tissue.

Most surgical interventions for pleural empyema are characterized by trauma and significant blood loss.

Chronic pleural empyema develops after acute pleural empyema within 2.5 to 3 months.

The main reason leading to the transition of an acute empyema into a chronic one is the incomplete expansion of a collapsed lung and the formation of a residual pleural cavity. Reasons preventing the expansion of the lung:

1. Too late and insufficient removal of pus from the pleura;

2. Violation of the elasticity of the lung due to fibrinous changes in it;

3. Due to inflammatory changes in the pleural sheets, their thickening;

4. The presence of a broncho-pleural fistula.

In addition, pleural empyema may be supported by rib osteomyelitis, a foreign body.

Clinically, the transition from acute to chronic empyema is characterized by an improvement in the general condition, a persistent decrease in temperature, a decrease in leukocytosis, normalization of the composition of white blood, and a decrease in purulent discharge from the pleura. At the same time, the dimensions of the residual cavity are stabilized. With a delay in the outflow of pus from the pleural cavity, the patient's condition worsens, while the temperature rises, cough and pain in the chest increase, and the patient's exhaustion increases.

Accurate determination of the size and shape of the residual cavity is of great importance for the choice of a treatment method. For this purpose, the following are produced:

1) pleurography;

2) tomography;

3) thoracoscopy.

Conservative treatment rarely leads to recovery. The main objectives of surgical treatment are the elimination of the residual cavity and the closure of the pleurobronchial fistula. This can be achieved in the following ways:

1) mobilization of the chest wall to collapse the chest (thoracoplasty);

2) the release of the lung from the seam (its decortication);

3) filling of the residual cavity with living tissues (myoplasty);

4) wide opening of the residual cavity, with resection of the ribs covering it and tamponade with Vishnevsky's ointment.

Control questions

1. What is pleural empyema?
   1. Etiology and pathogenesis of this disease.
   2. Classification of pleural empyema.
   3. Features of the clinical picture of the disease.
   4. Methods for diagnosing pleural empyema.
   5. Indications for pleural puncture.
   6. Types of drainage of the pleural cavity in pleural empyema.
   7. Principles of conservative therapy.
   8. What is chronic pleural empyema?
   9. Surgical options for chronic pleural empyema.
   10. Rehabilitation. Employability examination.

Rehabilitation and examination of working capacity in suppurative diseases of the lungs and pleura

Restoration of working capacity of patients with lung abscess is possible during conservative (antibiotics, sulfonamides) and surgical treatment. In patients who underwent surgical treatment, depending on the outcome of the operation, the ability to work is determined by the severity of intoxication, the degree of respiratory failure, the type and working conditions. With mildly pronounced functional disorders and the absence of contraindicated factors in the main profession, it is recommended to extend the sick leave. With extensive operations (pneumonectomy and lobectomy), patients are partially able to work, and sometimes they are recognized as disabled for one year after the operation. In young people, retraining, retraining is recommended. In patients who have undergone pneumoectomy, disability group III is determined without a re-examination period. Patients who have undergone surgery are taken to the dispensary by the surgeon. Patients who underwent conservative treatment are observed by a therapist.

Situational tasks

(on the topic "Suppurative diseases of the lungs and pleura")

1. A child aspirated a sunflower seed 2 months ago. After 3 days, the seed was removed through a bronchoscope, but the patient had a cough, especially in the morning, a small amount of sputum with pus began to appear, sometimes the temperature rose to 37.5 - 38 ° C.

On examination, the patient noted lagging of the left half of the chest during breathing. With percussion - shortening of the percussion sound under the left shoulder blade. Auscultatory - weakened breathing in the lower sections of the left lung behind. Blood test without features. On x-ray examination, the lung fields are transparent, but the left lung field is darkened, the diaphragm is raised and the mediastinal shadow is shifted to the left.

What diagnosis will you make? What additional research can confirm it. How to treat the patient?

2. A 50-year-old patient was admitted to the clinic with complaints of weakness, cough with a small amount of purulent sputum, evening temperature rises up to 38o.

From the anamnesis it was found out that a month before the admission he suffered from the flu. Treatment at home. An X-ray examination on the 8th day revealed an infiltrate in the upper lobe of the right lung with a decay cavity in the center.

What diagnosis will you make? What is your tactic? What additional methods of examination will you undertake to clarify the diagnosis?

3. In a 45-year-old patient, after hypothermia, the temperature rose to 39o, pain appeared in the right half of the chest, aggravated by breathing, cough without sputum. Despite intensive treatment, the temperature persisted for 8 days. Then the patient began to separate a large amount of purulent sputum with an unpleasant odor, and the temperature dropped, he began to feel better. Under the right scapula began to be determined by the shortening of the percussion tone, the weakening of breathing. No other pathology was identified.

What disease do you suspect in the patient? What additional research methods should be carried out to clarify the diagnosis?

4. A 42-year-old patient was treated for a month and a half in the therapeutic department for an acute abscess of the upper lobe of the left lung. Treatment is carried out: intramuscular injection of penicillin and streptomycin, vitamin therapy, administration of glucose and calcium chloride. However, the patient's condition almost does not improve - he is in a fever, he is worried about coughing with periodic separation of fetid sputum.

What mistakes are made in the treatment of the patient? What should be done now?

5. A 17-year-old patient admitted to the clinic with complaints of cough with purulent sputum, shortness of breath when walking. History of frequent pneumonia since childhood. The boy did not develop well, often missed classes at school.

Upon admission to the clinic, the patient's condition was satisfactory. Nutrition is reduced, pale, cyanosis of the lips. Fingers in the form of "drum" sticks. "In the lungs on both sides, profuse moist rales are heard mainly above the lower fields.

What is your diagnosis? What methods of examination can confirm it? How to treat the patient?

Answers

1. A child has left lower lobe aspiration pneumonia, which may be an infiltrative phase of a developing pulmonary abscess. This can be confirmed by polypositional X-ray examination and tomography. Treatment is conservative: antibiotics, sulfonamides, expectorants, cardiovascular drugs, restorative treatment.

2. A patient has a post-influenza abscess of the upper lobe of the right lung. To clarify the diagnosis, a polypositional x-ray examination, tomography is necessary. Within 6-8 weeks from the moment of formation of an abscess that does not communicate with the bronchus, conservative measures using broad-spectrum antibiotics can be successful in 70% of patients.

3. A patient has an abscess in the right lung with a breakthrough in the bronchus. Along with a complete x-ray examination, diagnostic and sanitation bronchoscopy is indicated, which should be supplemented by a complex of anti-inflammatory, restorative and immunostimulating treatment.

4. If conservative treatment of a patient with an abscess of the upper lobe of the left lung fails for 6-8 weeks, pneumotomy should be performed. This operation, providing good drainage of the abscess, creates conditions for the rapid healing of the cavity.

5. The patient has bronchiectasis. The diagnosis can be confirmed by multi-axis x-ray, tomography, bronchography. Given the advanced stage of the disease with the spread of the process to both lungs, one should start with conservative treatment, which includes, along with the use of the entire complex of therapeutic measures, bronchoscopic sanitation. This option should be considered as the basis for preoperative preparation of the patient, which can reduce the risk of radical surgery for the patient. At the next stage, it is possible to apply a radical operation (segmental resection of the lung or lobectomy) alternately.

LITERATURE

1. 1. Amosov N. M. Essays on thoracic surgery. Kyiv, 1958.
2. 2. Kolesnikov I. S., Lytkin M. I., Lesnetsky L. S. Gangrene of the lung and pyopneumothorax. L., 1983.
3. 3. Lubensky Yu. M., Rappoport Zh. Intensive care of pulmonology. L., 1977.
4. 4. Maslov V. I. Treatment of pleural empyema. L., 1976.
5. 5. Putov N.V., Fedoseeva G.B. Guide to pulmonology. L. "Medicine", 1984
6. 6. Pods V. I. Purulent diseases of the lungs and pleura. L., 1967.

The clinical picture in all forms of chronic suppurative processes of the lungs is determined by the stage of the course of the disease, i.e., those changes that have developed in the respiratory, cardiovascular, nervous, excretory, hematopoietic and other systems. These changes and symptoms are caused by purulent intoxication and hypoxemia. Diagnosis of chronic pulmonary suppuration is sometimes associated with significant difficulties encountered in the diagnosis of initial forms of suppuration, small abscesses, when ...

Most surgeons and therapists now recognize that all therapeutic methods for the treatment of chronic suppurative processes and their exacerbations give only a temporary effect, they only allow to transfer the exacerbation phase to the remission phase, to reduce perifocal inflammation. Intramuscular, intratracheal and intrapulmonary use of antibiotics, complex bronchial sanitation lead not only to a decrease in inflammation in the lung tissue, but also ...

An important role in the development of cough is played by the constant irritation of the mucous membrane of the bronchi and trachea with purulent sputum, which leads it to a state of constant inflammation. Inflammatory infiltration of the mucous membrane of the bronchi and trachea, irritating the nerve endings, leads to the development of severe coughing attacks. Purulent sputum is the second constant sign of pulmonary suppuration that helps make the diagnosis. This sign is weakly expressed in ...

Indications for surgical treatment are determined by the duration of the disease and mainly by the form and prevalence of the process, and the possibility of performing an operation is associated with the state of the functions of organs and systems, which can be changed in a favorable direction by preoperative preparation. Radical lung surgeries give the best results during remission. The most favorable outcomes of surgical treatment were observed in patients with early phases ...

However, it should be remembered that patients may have two diseases at the same time, one of which may be tuberculosis. V. A. Zhmur (1959) reports that anaerobic microflora was found in sputum and contents of cavities obtained during operations in 43.3% of patients. A sign of the collapse of the lung tissue is the presence of elastic fibers in the sputum. In a routine study, they are found in 25 - ...

Of course, with the defeat of the entire lung, pulmonectomy is indicated, with the defeat of one lobe - lobectomy, and with a clearly expressed defeat of one segment - segmental resection. Significant difficulties are encountered when choosing an operation in cases where the process has spread from one lobe to another, but part of the lung tissue is still functioning. Operations for chronic suppurative processes of the lungs should be really ...

Chest pains appear when the inflammatory process passes to the parietal pleura and chest wall and spreads to the nerve elements, i.e. in advanced phases. Most often, chest pains are noted in the third and fourth phases, much less often in the second phase, and very rarely in the first phase of the course of chronic suppuration. On average, this symptom ...

Exacerbations of the process, of course, are an indicator of a weakening of the body's defenses or an increase in the virulence of the microflora. Either one or the other is highly undesirable during an operation, when increased demands are placed on the body. The clinical experience of many authors, including ours, convincingly confirms the greater safety of radical operations during remissions. If persistent preoperative preparation fails to achieve remission…

The symptomatology revealed by percussion and auscultation is very diverse and is determined by the nature and severity of anatomical changes in the lung and pleura and the localization of the process. With a significant spread of the process in the lung and the development of inflammatory infiltration or pneumosclerosis, usually during percussion, the muffling of percussion sound over the affected area of ​​\u200b\u200bthe lung tissue is clearly determined. In the initial stages of the process, especially at a deep location ...

Purulent intoxication in chronic suppurative processes of the lungs significantly disrupts the activity of the hematopoietic organs. Meanwhile, radical operations on the lungs are associated with significant blood loss and the possibility of developing severe anemia, which is highly undesirable with a sharp reduction in the respiratory surface of the lungs, as this leads to an even greater deepening of hypoxemia. Normal and even enhanced function of hematopoietic organs in the preoperative period ...

Pleurisy is a disease in which the inflammatory process affects the parietal and pulmonary layers of the pleura (lung membrane). Purulent pleurisy - a secondary disease, inflammatory diseases of the lungs. Most often it is a complication of croupous, post-influenza pneumonia. It is characterized by the accumulation of pus in the pleura.

There are parapneumonic and metapneumonic purulent pleurisy. The first occur during the active period of pneumonia. The latter are more common and appear after treatment.

By what signs is purulent pleurisy of the lungs determined, treatment, symptoms, consequences of this disease, what are they? Let's talk about it:

How is purulent pleurisy of the lungs manifested? Condition symptoms

The characteristic signs of this disease include: acute pain, heaviness, a feeling of fullness, fullness in the side, shortness of breath, when it is difficult to breathe deeply. Patients have cough, shortness of breath, fever, general weakness. Pain with purulent pleurisy is strong, acute. However, as the purulent exudate accumulates, it weakens.

The cough is usually dry. Only with secondary pleurisy, when it is a complication
pneumonia, or with a lung abscess, mucous sputum is secreted, interspersed with pus.

Often the cough is painful, paroxysmal. Usually worries at night.

In addition, the body temperature rises significantly, often up to 39-49 degrees. The temperature may be constant or intermittent. The pulse can reach 120-130 beats. min. This is determined by the development of purulent intoxication, as well as by the fact that the heart is slightly shifted to the side due to accumulated exudate.

If the patient is not provided with timely medical care, a breakthrough of pus into the pleural cavity is possible. In addition, during the period of development of the inflammatory process, in addition to pus, the pleura accumulates air. This condition is called pyopneumothorax. In this case, the patient is tormented by severe pain and shortness of breath.

With the advanced form of the disease, scars, adhesions are formed, bronchiectasis develops. The inflammatory process takes a chronic form with periodic periods of exacerbations.

How is purulent pleurisy of the lungs corrected? Treatment of the disease

Therapy of purulent pleurisy consists in eliminating the infection, signs of intoxication, as well as restoring the normal functioning of the affected organs.

The primary task is to eliminate the purulent focus with subsequent expansion of the lung. Upon reaching the fusion of the parietal, visceral pleura and obliteration of the purulent cavity, recovery occurs. The main thing is to start treatment on time, until during the process of inflammation moorings (dense fibrous tissue) form in the pleura and the disease takes a chronic form.

The patient is undergoing procedures for pumping out purulent exudate. At the same time, penicillin is injected into the pleural cavity (according to indications - streptomycin). Penicillin is also administered intramuscularly. If necessary, blood transfusions are performed. According to indications - transfusion of blood plasma or erythrocyte mass.
In severe cases, surgical treatment with resection of the rib is prescribed.

What threatens purulent pleurisy of the lungs? Consequences of the disease

Purulent pleurisy of the lungs treatment of the symptoms of which we examined today is a very serious disease. With a neglected, untreated disease, complications are possible that are life-threatening for the patient. These include: the appearance of adhesions, bronchopleural fistulas, as well as a violation of local blood circulation, due to compression of the vessels by exudate. In addition, due to prolonged purulent pleurisy, kidney damage occurs.

The most severe consequence of purulent pleurisy is pleural empyema. This pathology is characterized by the accumulation of purulent contents in the lung, with the formation of a free cavity - a "pocket". After that, scarring of the pleura occurs with complete blockage of the lung.

Also, a very serious consequence of a neglected disease is amyloidosis of parenchymal organs. Similar complications of purulent pleurisy are fatal in half of all cases. They are especially difficult for weakened people, the elderly and small patients.

How does traditional medicine correct purulent pleurisy of the lungs? Alternative treatment

We note right away that this dangerous disease cannot be cured with folk remedies. However, with the permission of the attending physician, they can be used as an addition to the main therapy. Here are a couple of useful recipes that can alleviate the patient's condition:

Prepare freshly squeezed juice from peeled black radish. Mix it with honey, keeping the proportion 1x1. Take 1 tbsp. l. three times a day.

Every evening, apply a compress of warm mashed potatoes mixed with honey to the chest area. Spread the mixture over a dense fabric, wrap it, then attach it to a sore spot. Be healthy!