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1、血源性肺脓肿血源性肺脓肿Blood-borne lung abscess 血源性肺脓肿的概述血源性肺脓肿的概述血源性肺脓肿是因皮肤外伤感染、痈疖、骨髓所致的败血症、脓毒菌栓经血行播散到肺，引起小血管栓塞、炎症、坏死而形成肺脓肿。常为两肺外周部的多发性病变。致病菌以金黄色葡萄球菌为常见。血源性肺血源性肺脓肿的体征的体征 与肺脓肿的大小和部位有关。病变较小或位于肺脏的深部，可无异常体征。病变较大，脓肿周围有大量炎症，叩诊呈浊音或实音，听诊呼吸音减低，有时可闻湿罗音。血源性肺脓肿体征大多阴性。慢性肺脓肿患者患侧胸廓略塌陷，叩诊浊音，呼吸音减低。可有杵状指（趾）。An overview of bloo
2、d-borne lung abscess Blood-borne lung abscess was due to the skin of sepsis caused by trauma,infection,carbuncle furuncle,bone marrow,pus,blood line of toadstool bolt spread to the lungs,causing small vascular thrombosis,inflammation,necrosis and form lung abscess.Often for both multiple lesions of
3、lung peripheral units.Pathogenic bacteria staphylococcus aureus as common.Blood-borne signs of lung abscess Related to the size and the location of a lung abscess.Lesions or smaller of deep in the lungs,but no abnormal signs.Pathological change is bigger,abscesses surrounded by a large number of inf
4、lammation,percussion is voiced or flatness,decreased auscultate breath sounds,sometimes audible wet rale.Blood-borne lung abscess signs are mostly negative.Chronic lung abscess patients with lateral thoracic slightly sunken,percussion dullness,decreased breath sounds.Can have clubbing(toe).血源性肺脓肿的诊断
5、血源性肺脓肿的诊断 依据口腔手术、昏迷呕吐、异物吸入，急性发作的畏寒、高热、咳嗽和咳大量脓臭痰等病史，结合白细胞总数和中性粒细胞显著增高，肺野大片浓密炎性阴影中有脓腔及液平面的X线征象，可作出诊断。血、痰培养，包括厌氧菌培养，分离细菌，有助于作出病原诊断。有皮肤创伤感染，疖、痈等化脓性病灶，发热不退并有咳嗽、咳痰等症状，胸部X线检查示有两肺多发性小脓肿，可诊断为血源性肺脓肿。Blood-borne the diagnosis of lung abscess According to oral surgery,vomiting,coma eyewinker inhalation,acute ep
6、isodes of chills,fever,cough and cough a lot of history of purulent sputum,etc,combined with the total number of white blood cells and neutrophils significantly higher,vast dense inflammatory lung shadow with pus cavity and the fluid level in the X-ray signs of,can make a diagnosis.Blood and sputum
7、culture,including anaerobic bacteria cultivation,separation of bacteria that can help make a pathogen diagnosis.Skin wound infection,furuncle,carbuncle suppurative lesions,fever is not retreated with symptoms such as cough,sputum,chest X-ray shows there are two small multiple pulmonary abscess,lung
8、abscesses,can be diagnosed with blood-borne.血源性肺脓肿的血源性肺脓肿的X线检查线检查血源性肺脓肿在一肺或两肺边缘部有多发的散在小片状炎症阴影或边缘较整齐的球形病灶，其中可见脓腔及液平面。炎症吸收后可呈现局灶性纤维化或小气囊。并发脓胸者，患侧胸部呈大片浓密阴影；若伴发气胸则可见液平面。侧侧位位X线检查线检查 可明确脓肿在肺脏中的部位及其范围大小，有助于作体位引流或外科治疗。胸部胸部CT扫扫描描 多呈类圆形的厚壁脓腔，脓腔内可有液平面出现，脓腔内壁常表现为不规则状，周围有模糊炎性影。纤维纤维支气管支气管镜检查镜检查 有助发现病因，若为支气管肿瘤，可摘取
9、作活检。如见到异物可摘出，使引流恢复通畅。亦可借助纤维支气管镜防污染毛刷采样细菌培养以及吸引脓液和病变部注入抗生素，促进支气管引流和脓腔的愈合。Blood-borne X-ray examination of lung abscess Blood-borne lung abscess in the lung or two edges of multiple scattered on the edge of the small flake inflammation shadow or a neat spherical lesions,including visible pus cavity an
10、d the fluid level.After inflammation absorption can present focal fibrosis or small air sacs.Concurrent pyothorax,with lateral chest show large dense shadow;If the fluid level with pneumothorax were visible.Side a X-ray Can clearly define the location and size of abscess in the lung,and helps make p
11、ostural drainage or surgery.Chest computed tomography(CT)scan Formed a kind of circular thick wall of the pus cavity,pus cavity fluid level can occur,the pus cavity wall is often characterized by irregular shape,fuzzy inflammatory shadow around it.Fibre bronchoscopy Help to find the cause,for bronch
12、ial tumor,can gather the biopsied.Such as see the foreign body can be picked out,restoring the drainage unobstructed.Also with the aid of fiberoptic bronchoscopy pollution prevention brush sampling bacteria culture and attract the pus and pathological changes of injection of antibiotics,promote the
13、healing of bronchial drainage and pus cavity.血源性肺脓肿的治疗血源性肺脓肿的治疗血源性肺脓肿为脓毒血症的并发症，应按脓毒血症治疗。（一）（一）痰液引流痰液引流 祛痰药如氯化铵0.3g、沐舒痰30mg、化痰片500mg、祛痰药10ml，每日3次口服，可使痰液易咳出。痰浓稠者，可用气道湿化如蒸气吸入、超声雾化吸入等以利痰液的引流。患者一般情况较好，发热不高者，体位引流可助脓液的排出。使脓肿部位处于高位，在患部轻拍，23次/d，每次1015分钟。有明显痰液阻塞征象，可经纤维支气管镜冲洗并吸引。（二）外科治（二）外科治疗疗 支气管阻塞疑为支气管癌者；慢性肺
14、脓肿经内科治疗3个月，脓腔仍不缩小，感染不能控制；或并发支气管扩张、脓胸、支气管胸膜瘘；大咯血有危及生命之虞时，需作外科治疗。（三）中（三）中药药治治疗疗 败脓强肺草 鹅掌柴、千年润、美醉、黄花龙芽、黑九牛等草药，清热益肺、止咳化痰、消痈排脓，主治肺脓肿。一日一付药，煎好分三碗，早中晚各一碗服下，15付一疗程。Blood-borne treatment of lung abscess Blood-borne lung abscess of septic complications,should be treated according to sepsis.(1)the sputum drain
15、age Expectorant such as ammonium chloride 0.3 g,30 mg MuShu phlegm,phlegm 500 mg,expectorant,10 ml,orally,three times a day can make easy to produce sputum.Thick sputum,airway moist available such as steam inhalation,ultrasonic atomization inhalation sputum drainage.Patients with general condition i
16、s good,warm,postural drainage can help discharge of pus.Abscess areas are high,with the tap,2 3 times/d,10 15 minutes at a time.Have obvious sputum blocking signs,washing and attract by fiber bronchoscope.(2)surgery Bronchial obstruction suspected bronchogenic carcinoma;Chronic lung abscess after me
17、dical treatment for 3 months,the pus cavity is not narrowed,infection cant control;Or complicated by bronchiectasis,pyothorax,bronchial BPF;Big haemoptysis concern have life-threatening,requiring surgical treatment.(3)traditional Chinese medicine treatment Defeat strong pus lung grass Schefflera,one
18、 thousand,nine dragon of drunk,chrysanthemum buds,black cattle such as herbal medicine,heat profit lung,cough phlegm,anti abscess,lung abscesses,attending.1,a pair of medicine,and three dishes,each take a bowl of middle-late early,15 to pay for a course of treatment.谢谢关注谢谢关注Thank you for your attention