Chronic pleurisy code according to ICD 10. Pleural empyroidism

Empiric pleurisy is the middle of the lungs in the area of pulmonology and also illnesses, also under the name of pyothorax and gnarial pleurisy. Pathology is characterized by the flames and the purchase of the great commitments of the exudate in pleural emptying... In the case of a large number of diseases, it is of a secondary nature, that is, it is formed on the basis of a host of chronic or chronic processes, which negatively infuses on the lungs of the bronchi. In some cases, fiery growths develop as a result of trauma to the breast cancer.

Pyothorax is not a specific clinical picture - the power of a great number of illnesses is in power, and the legends are hostile. Some of the most common symptoms are such as the increase in temperature indicators, lack of sweatiness, chills and dullness.

put correct diagnosis a clinician who can only live by the patient's instrumental conditions. In addition, the diagnostic process also includes laboratory tests and a number of manipulations, which are especially useful for testing.

The tactics of therapy will be dictated by the option of overcoming the ignition process, for example, when the form is in the first place, conservative methods are used, and when chronic - most often it turns to surgical involvement.

In the international classification of ailment of the tenth glance, such a pathology is not very close to the cipher, but is placed in the category "Inshi pleural damage". Thus, the code for the MKH-10 will be J94.

Ethiology

Oskіlki zapalennya s vognische in the pleural emptyness can be the first and second, then the friendly factor is taken to a number of categories. Most often, in about 80% of situations, pathology develops on the basis of only other pathological processes, which can be caused by:

formulation;
oncology of the given region;
abo;
lung;
gnіynі processes in independence from localization;
і gnіynniki in pechіntsі;
having cut the stravohode;
Infections of the organs of the mental system;
the transfer of ailments bacteria with a stream of lymph or blood from the others. Naybils are often fungi, tuberculous sticks, and anaerobic bacteria.

The primary rate of pleurisy in the most important situations develops through:

wound or traumatic damage to the structural integrity of the breast tissue;
thoracoabdominal ear of the sternum;
previous operations, which may be the cause of the establishment of bronchial fistulas.

With the use of a food-grade drink, the triggering mechanisms of the ailment cause a decrease in the immunity of the immune system, penetration of blood into the pleural empty space, as well as pathogenic microorganisms.

Classification

Allowing for vyshchevkazanі ethiological factors, it is accepted to see such types of ailments:

parapneumonic;
pislyaoperats_yny;
post-traumatic;
metapneumonic.

Under the pathological process in the fallowness of the triviality of the process:

gostra empієma pleurisy - є such that the symptomatology is less than a month;
subacute pleurisy rate - key signs ailments affect people from 1 to 3 months;
Chronic pleural tempo is a classic picture that does not go away for more than 3 months.

I will look at the nature of the fiery exudate pyothorax buva:

gnіynim;
rotten;
specific;
zm_shanim.

Classification for the expansion of the display and the wideness of the transmission of transmission:

unilateral and bilateral pleurisy;
total and subtotal pleurisy;
by the pace of pleurisy, yak, in its own heart, extends to the apical or upper, paracostal or parietal, basal or supraphrenic, interlobar and paramedial.

For the obsitations of the seen with pus, they will:

small rate - from 200 to 250 mln;
average rate - from 500 to 1000 mln;
a great rate - more than 1 liter.

Krim tsyogo, pathology buvak:

zakrityu - tse means, scho gn_yno-igniting rіdina not to be named;
vidkrito - in such situations, fistulas are formed on the patient, for example, Bronchopleural, pleurodermal, bronchopleural and pleuropulmonary.

In the world of its own progress, the pace of pleurisy goes through a series of stages of development:

serous - against the formation of serous vipot in the empty pleura. Freely distributing the therapy for the first time. In the case of inadequate antibacterial speeches of the disease, they go into the offensive form;
fibrous-gn_inu - on the basis of the increase in the number of pathogenic bacteria, the ignition ridina becomes kalamutnoy, that is, gn_ine. Krym, there is a fibrous deposit and adhesions;
fibrous organization - the formation of schilny pleural shkvarty - the stench yak carapace will cover the ailment easier.

symptomatology

A clever picture in the state of the art and chronic options for overcoming ailments will often be seen. For example, the symptoms of pleurisy in the hospital form are presented:

a strong dry cough, which after a dozen hours becomes productive, that is, from the sight of sputum - there can be mother sirim, zelenuvatim, zhovtuvati or іrzhavym vidtіnkom. Frequently the sputum is superfluous with a stinking odor;
zadishkoyu, scho vinikє yak on tli physical activity, So i am calm in the camp;
adjustments of temperature indicators;
pain in the sternum, scho z'yavayutsya on inhalation and vidikha;
organism;
Decrease in preference;
Possibly rozbitostі;
weakness and swift stomachache;
decreased appetite;
blueness of the lips and fingers;
damage to the heart rhythm.

Approximately in 15% of vypadkіv hospitality intermittently go into chronic, as it appears as a weak manifestation of the symptoms indicated above, or the presence of deformity of the breast, and headache.

diagnostics

In order to put the correct diagnosis, it is necessary to establish the whole complex of calls - to fix it from a physical view and to complete it with instrumental procedures.

The first stage of diagnostics of corrections by the clinician of such manipulations:

vivchennya іstorії ailments - for the joke of a pathological factor, which served as a dzherel for the development of the ignition process in the pleural emptying;
check and analysis of life history - to establish the fact of trauma to the sternum or transferred surgery in the whole region;
retelny look at the breast, listening behind the help of the phonendoscope with the obovyazkovuyu percussion;
more detailed experience of a sick person - for the establishment of the first hour, the symptoms and signs of the stage of the turn will appear. Such information is in addition to helping to determine the nature and form of the resistance to pathology.

Another way to diagnose the transfer of such laboratory tests:

zagalnokl_n_ichny blood analysis;
bacterial seeding of ignition exudate;
biochemistry of blood;
smear bacterioscopy;
microscopic treatment of aspirated birth and sputum;
zagalny analiz urini.

The final stage in the diagnosis of pleurisy rates is the instrumental procedure. Before them it is easy to add:

radiography of the sternum;
pleurofistulography - show the appearance of fistulas;
ultrasonography of pleural emptying;
CT and MRI light;
pleural puncture.

Additional ailment from differentiation to:

fiery battle of legends;
і lung abscess;
specific pleural lesions;
evil or good-hearted fucking legends.

lykuvannya

Usunennya of such an affliction is based on the use of both conservative and surgical therapeutic techniques. Inoperable therapy tactics include:

Entry anti-microbial;
oral intake of antibacterial speech;
disintoxication;
storage of vitamins;
transfusion of alcoholic preparations, solutions with glucose and electrolytes;
plasmapheresis and plasmacytopheresis;
hemosorption і UFO blood;
dichny gymnastics and exercise therapy;
ultrasound;
lykuvalny massage breast cells, which can be vibratsyinyh, percussion and classic.

Conservative therapy is also the transmission of folk medicine practices, protest alternatively to treatment, it is guilty that it is necessary to use a doctor. Such a variant of the merging of the ailments of the straightening for the preparation of the items, before the warehouse of which there may be included grassesі roslini:

anіs і licorice;
marshmallow and shavlya;
polovy horsetail і dried flowers;
quotations of lime and birch brunka;
mother-and-machuha and the root of Oman.

Krim tsyogo, folk medicine is not zaboronyaє vikoristannya:

I will drink cibulini juice and honey;
the sum of the pulp of cherries and olive oil;
zilla with aloe juice and lime honey;
juice of black radish, mixed with honey.

Hirurgical treatment of pleurisy permits:

evakuyuvati gn_yniyeksudat;
change of intoxication;
easier to correct;
lіkvіduvati empty empієmi.

The operation can be carried out in a number of ways:

lykuvalnoy bronchoscopy;
pleurectomy with additional decortication of the ailing lung;
thoracostomy - tse vіdkrite draenuvannya;
interpleural thoracoplasty;
zakrittam bronchopleural fistula;
resection of the leg.

Likarske getting involved in most often gets stuck in case of chronic overload of ailments.

Unimportant to the current therapy of pleuritic edema is a process, important and folding process, it is practical to wait for the urge to try again.

may you expedite

Filling of pleural leaves can lead to such inheritances:

dystrophic changes of the liver, nirok and myocardium;
formation of blood clots;
septicopyemia;
Bronchopleural fistula;

Prevention and forecast

To reduce the quality of the development of the pace of the pleurisy, go to the front, the middle:

advancement of the immune system;
unique trauma and injury to the breast;
if necessary, the operation on the sternum can be used for minimally invasive techniques;
a frequent occurrence and complex treatment of any infectious processes in the body, as well as an ailment, which can lead to a fiery lesion of pleurisy;
Regularly introduce a medical mortgage for a regular prophylactic examination.

The forecast of such ailments is most often hospitable - zavdyaki complex therapy to give in to the full extent of the burden. However, it means that about 20% of the patients are more likely to experience an acceleration. Mortality in the diagnosis of the rate of pleurisy in the warehouse is 15%.

Professor P.K. Yablonsky (St. Petersburg, Professor O. G. Sokolovich (St. Petersburg), Associate Professor V. V. Lishenko (St. Petersburg, Professor I. Y. Motus (Yekaterinburg), Candidate of Medical Sciences S. A. Skryabin (Murmansk) ...

The empire of pleurisy is not for self-inflicted illnesses, but for accelerated pathological conditions. However, it is seen in the context of a nosological unit in conjunction with the same type of clinical picture and clinical visits. In these key recommendations of the rate of pleurisy, it is presented as a three-stage discomfort in the type of classification of the American Thoracic Suspension (1962). This kind of thinking is derived from the traditional gradation of emptiness to hospitality and chronicity, adopted by the most recent medical practice. When the victories lіkuvannya got sick into the distance uniqueness rubbing against the foreign and vital steps.

In these key recommendations, there is no need to look at the tactics of eliminating the bronchial tube disability due to lobectomy and pneumonectomy as the cause of the development of pleurisy, as well as methods of preventing disability. Tse є drive for an okremy document. The tuberculous rate of pleurisy (as an accelerated fibro-cavernous tuberculosis and as an expedited operative engagement) is not included in the recommendation given in connection with the peculiarities of interruption of the disease.

Empiric pleurisy (gnarial pleurisy, gniy) is the purchase of pus and biologic signs of information in pleural emptyings from the firing process of partial and visceral pleural tissue. Cody MKX-10: J86.0 pyothorax with fistula J86.9 pyothorax without fistula.

With the minds of the empimi pleurisy є:

the appearance of birth in the pleural emptying as a result of the development of the primary pathological process (non-bacterial pleurisy, hydrothorax) or injuries (including surgery);
information on pleural emptying and development fierce fire The peculiarities of the abnormalities are beginning to become resistant to organisms, virulent microorganisms;
minds for the distribution of the collaborated lung and elimination of pleural emptying (fistula, sclerotic processes in the leg parenchyma).

To that specific prophylactic come in, so that you allow the detection of the blight in the pleural empty space, glance at the alternate factors:

Organizatsiynі come in:
1. in the introduction and suvore of the protocols for the treatment and prevention of malarial and internal carnial pneumonia, for perioperative empirical antibacterial therapy in thoracic surgery;
2. organization of free-of-charge hospitalization of patients with pneumonia, abscesses of legacies, bronchiectatic ailments, tuberculosis in specialized pulmonological, thoracic surgery and phthisiatric diseases;
3. organization of free emergency medical specialized thoracic surgical aid for pneumothorax, malnutrition and wounds of the breast;
come in:
1. rational empirical antibacterial therapy of grievous illnesses of legends, based on the principles of deeskalatsiya with urahuvannya donations of local microbiological monitoring of a particular hospital;
2. the improvement of the drainage function of the bronchi in ailments with suppurative diseases of the legends;
3. Freely punctual vipotus with pleural emptying in ailments with pneumonia (if indicated) with obovazkovy microbiological dosages;
4. Freely punctual visible transudate from pleural emptying (if it is shown) at camps, which are being accumulated, with obligatory microbiological dosages;
5. obmezhennya showing before the drainage of pleural emptying without vagomikh for those children with transudate and small (clinically insignificant) exudate in the pleural emptying;
6. vistavlennya testimony before operative treatment in case of "blocked" abscesses of the leg, gangrene of the lung, bronchiectatic ailments;
7. Determination of the lasting drainage of the "blocked" abscess (if it is indicated), only from the data of the computer tomography (if it is evident, there is an increase in the number of pleural emptyings);
8. rational perioperative antibiotic prophylaxis in thoracic surgery;
9. The information about the operation in patients with spontaneous pneumothorax in case of collapse of the legacy and / or loss of drainage from the pleural empty space is accepted;
10. storing additional methods of aerostasis of legacy tissue and improvement of bronchial tubes during an hour of operative work;
11. rational drainage of pleural emptying before an hour of operative engagement;
12. retreat looking for drainage in the pleural emptying;
13. Quickly visible drainage from the pleural emptying for operative insertion on the organs of the breast;
14. often and adequately to detect pathological processes in the subphrenic space (abscesses, gostry pancreatitis), Breast School.

Vyavlennya empієmi pleurisy

Regular X-ray radiography of the organs of the breast cancer with advanced ultrasound diagnostics and / or computer tomography (if indicated) for the quick detection of vipot in the pleural empty spaces in the advanced groups of patients:
1. in patients who are in therapeutic and pulmonary diagnoses with the diagnosis "pneumonia" - skin 7-10 days; when there is a positive dynamics of the disease, the computer tomography of the organs of the breast is displayed, and the onset of the radiography of the lungs is displayed for the skin 5 days;
2. in patients who are found in thoracic surgical diagnoses with diagnoses of "abscess of a leg without sequestration", "abscess of a leg with sequestration", "gangrene of the lung", - skin 7-10 days; when there is a positive dynamics of the cycle, the computer tomography of the organs of the breast is repeated;
3. in patients with trivial post-treatment regime with non-genetic diseases (in reanimation, toxicological, neurological and neurosurgical cases of mental impairments, mental deficiencies, 7-10 in case of unclear roentgenologic vignischevic abnormal changes, a computer tomography of the organs of the breast cell is displayed;
4. at the boys who are on piece ventilation lungs without pneumonia, - skin 10 dB; if there is evidence of infiltration of legacy tissue and age in the pleural empty space - skin 5 dB;
5. in patients with sepsis (posalegenevia, without pneumonia) - skin 7-10 dB; if there is evidence of infiltration of legacy tissue and age in the pleural empty space - skin 5 dB; in case of unclear roentgenologic vignischevic abnormal changes, a computer tomography of the organs of the breast cell is displayed;
6. for patients with a trivial fever of an unclear genesis more than 1 time, they are shown radiological dosages; in case of unclear roentgenologic vignischevic abnormal changes, a computer tomography of the organs of the breast cell is displayed;
7. for patients who have aspirated into the tracheobronchial tree of a growing age - radiography after 1 dob, after 5 or 10 dB; if there is a legacy of information, the X-ray will last until the second light is removed, or up to 1-1.5 months.
Puncture of pleural emptying in case of clinically significant and available for puncturing purchase of vipot from patients of the named groups with a visual assessment, clinical analysis and microbial control.
Punctures of pleural emptying in camps, which are supervised by accumulated transudates (with clinical indications), with macroscopic control, backward-looking analysis and microbiological predictions.
Puncture of pleural emptying in patients in the early period of pneumonectomy (with clinical and radiological indications).

Classification of empires:

Native to the American Thoracic Suspension International Classification (1962) visualization of 3 clinical and morphological stages of incapacitation: exudative, fibrogenic, organisation. The exudative stage is characterized by the accumulation of information exudate in the pleural emptying as a result of the local increase in the penetration of the pleural capillaries. The accumulated pleural line instead of glucose, the pH value is too high. The stage of fibrinous-ginous is manifested in the form of fibrin (as a result of suppression of fibrinolytic activity), which is made of puff in the intervening growth from the encapsulation of pus and form of gnarly intestines. The growth of bacteria is supervised to increase the concentration of lactic acid and lower the pH value.

The stage of organisation is characterized by the activation of proliferation of fibroblasts, which leads to the appearance of pleural adhesions, fibrous spikes, which form intestines, and decrease the elasticity of pleural leaves. Clinically and radiologically, the stage of the clearing in the common stopping of the ignition process, the progressive development of the delimiting zone (mooring), which is also completely tissue-like, scarring of the pleural emptyness, which can be easily brought to a low level rakhunok preserving bronchopleural fistula.

R.U. Light proponated the class with parapneumonic vipot and pleurisy, which concretize the cutaneous stage of the vysokovikladenoi classification:

The stage is exudative:
- Class 1. Insignificant vipit: small number of births (<10 мм).
- Class 2. Typical parapneumonic vipit: amount of ridin> 10 mm, glucose> 0.4 g / l, pH> 7.2.
- Class 3. Non-folding near-cordonny vipit: negative results of smear smear after gram, LDH> 1000 u / l, glucose> 0.4 g / l, pH 7.0-7.2.
Stage of gn_yno-fibrinous:
- Class 4. Pleural dislocations (prostate): positive results of a smear for gram, glucose< 0,4 г/л, рН < 7,0. Отсутствие нагноения.
- Class 5. Pleural dislocations (folding): positive results for gram, glucose< 0,4 г/л, рН < 7,0. Нагноение.
- Klas 6. Simple empire: Evident gn_y, single gn_yny swelling or widening with pus along the pleural empty space.
Organizational stage:
- Class 7. Foldable speed: Evident, multiple, flexible, flexible mooring.

The practical significance of these classifications is in the fact that the stench allows you to get overwhelmed and because of the importance of tactics (Strange C., Sahn S.A., 1999). In the modern literature, it was taken in terms of tempo for the nature of the transition (and in the world for the time-based criteria): gostra and chronic (flash phase, remission phase).

Chronic pleurisy rate is the cause of an untreated pleurisy rate (Kupriyanov P.A., 1955). Often the reason for the transition from a hospitable process to a chronic and permanent form of pleural emptying in the presence of an appearance of gross destruction in the lung (abscess of tissue, gangrene), in the presence of - bronchopleural, pleuropulmonary. It is traditionally accepted in respect of the transition of the state empire into the chronicle - 2-3 months. However, such a rozpodil be clever in nature. In some children with circulating reparative health problems, there is a rapid growth of fibrinosis on the pleura, and in some of them there are processes of suppression, so that "fibrinolytic therapy" is adequate.

The most reliable criteria were formulated by chronic rates (based on the data of computer tomography):

rigid (anatomically non-reversible) thick-walled surplus empty, collapsing in the lung, with bronchialisalosis fistulas or without them;
morphological changes in the leg parenchyma (pleurogenic cyrosis of the leg) and the tissues of the breast.

The familiar development of chronic pleural infections due to pneumonectomy followed by the manifestation of pathological processes (bronchial fistulas, osteomyelitis of the ribs and sternum, nasal chondritis, aliens), To summarize the unpleasantness of liquidating the process in excessive emptying without additional surgery (pleurectomy, decortication, in addition to resection of the leg, ribs, sternum). Victory of the hourly official (3 months) є vypravdanim, the oscillos allow to obscure the number of dosages that are necessary for verification of diagnostics and assignment of adequate educational programs. An acutely chronic tempo of the stage of organization in the international classifications.

Behind the appearance of the most recent middle-rank, you see:

"Zakrytu", without a fistula (do not see it out of the calling middle);
"Vidkritu", with fistula (є the appearance of the lateral middle in the viglyad of pleurodermal, bronchopleural, bronchopleurocutaneous, pleuroorganic, bronchopleuroorganic fistula).

During the swearing of a pleural waste:

total (not visible on the x-ray radiographs);
subtotal (only the top of the legend starts on the x-ray picture);
Introduced (in case of encapsulation and anchorage to exudate): apical, pristinkova paracostal, basal, interlobar, paramedial.

For ethological factors, the following are developed:

parapneumonic and metapneumonic;
in the case of nasal-destructive illnesses (abscesses, gangrene, bronchiectatic ailments);
post-traumatic (chest trauma, lung injury, pneumothorax);
pislyaoperats_yna;
in case of post-mortem causes (pancreatitis, subphrenic abscess, liver abscess, firing of soft tissues and cystic frame of the breast cancer).

diagnostics of empієmi

General physical methods of conditioning... The presence of specific anamnestic and physical signs of robbing the diagnosis of pleurisy, especially parapneumonic, unobvious without instrumental methods of diagnosis. Verification of the diagnosis of "pleurisy rate" as well as reporting of up to one of the species, it is impossible without storing X-ray (including computed tomography) methods of preliminaries. Prote, okremi formi(The most important and not safe) ailments can be seen in a classy way.

pyopneumothorax- a type of pleural effusion (seecritic, with bronchopleural conditions), which I will occasionally tear into the pleural empty space of a Lehen gnarine. The main pathological syndromes in the case of iodine diagnoses are: pleuropulmonary shock (for the development of pus and symptoms of the great pleural receptor field); septic shock (as a result of the resorption of the pleura of the great number of microbial toxins); valvular stress pneumothorax with collapse of the leg, sharp changes in the middle from damaged blood flow in the system of empty veins. In the classic picture, they show heart-vascular deficiencies (depression of the arterial vise, tachycardia) and mental deficiencies (badness, venom, cyanosis). To that, the implantation of the term "pyopneumothorax" in the capacity of early diagnosis є eligible, as the case of the disease is called for the intensive care for the ailment, the prompt verification of the diagnosis "

Post-traumatic and pislyoperatsіynі, pleurisy to develop on the most important changes that are affected by trauma (surgery): damage to the integrity of the chest cell and associated with it the diseases of a callous disorder, a lung injury, and to induce a blood clotting of the bronchodilators At a number of early manifestations of the appearance of pleurisy (increased temperature of the heart, damage to the disease, intoxication), masquerading as such frequent accelerated trauma of the breasts, such as pneumonia, atelectasis, hemothorax;

Chronic pleurisy rate be characterized by signs of chronic gruesome intoxication, referring to periodic exacerbation of the gland process in the pleural empty space, which occurs on aphids pathological changes Chronic hypertrophy: bronchial fistulas, osteomyelitis of the ribs, sternum, and chondritis. An uncommon attribute of chronic pleural tempo is the stike of the overflowing pleural empty space with these walls, which can be stored from the strained layers of the brain. with good fabrics... Sclerotic processes develop in adjoining patients with legacy parenchyma, which leads to the development of a chronic process in the lung - chronic pneumonia, chronic bronchitis, Bronchiectasis, which may show its characteristic classic picture.

Laboratory methods for blood and blood tests... General analysis of blood and blood, biochemical analysis of blood aimed at detecting signs of toxicity and disease, organ deficiency.

In hospitals, the period of illness is indicated by leukocytosis with a circulating leukocyte formula, which is more significant than SHOE. In important cases, especially in the case of anterior viral infections, as well as in some destructive processes, leukocytosis may be insignificant, and some of the leukocytes may decrease, especially for the disease. Already in the first days, ailments, as a rule, a build-up of anemia, is especially pronounced with an uncomfortable interruption of ailments.
Hypoproteinemia is promoted, linked to the second bottle with sputum and gnaric exudate, as well as to the impaired synthesis of proteins in the liver through intoxication. To increase the level of C-reactive protein, lactate dehydrogenase, creatine kinase, transaminase. In the result of the reversal of catabolic processes, there may be changes instead of glucose in the blood. In the state of the art period, plasmas grow in place of fibrinogen, however, in case of a long period of time, it can change in the case of a breakdown in the synthesis of a protein in the oven. Hemostasis changes are manifested in the presence of fibrinolysis. The amount of circulating blood goes down more than half of the ailments, and moreover, it is more important for the globular debridement. Riska hypoproteinemia (3040 r / l) before the onset of embryos. The coverage of the line in the interstitial sector should be 1.5 liters in the middle, and the most ailing ones have a reach of 4 liters. Hyperamonitis and hypercreatininemia indicate an important, advanced chronic disease process, formulated chronic non-invasive deficiency in cases of amyloidosis nirok.
At this point, albuminous and granular cylinders appear as well. It is necessary to control the pitoma of the whale cut, in view of the possibility of the development of amyloid-lipoid nephrosis.
Bacteriological preliminaries of blood (seeding blood for sterility) in the presence of clinical and laboratory signs of sepsis and / or trivial fever.

Laboratory dosage of phlegm.

After reading the dobov part of the sputum, as you climb into the spout with a cry, you can screw up. Both the increase and the decrease in the number of sputum can be indicative of both positive and negative dynamics.
Bacterioscopic advances in phlegm allow for an open-minded judgment about the etiology of destruction, so as in smears it is clearly seen the important cultivation of microorganisms, in the winter, the inability of anaerobic diseases, that is, in the middle of aerobic diseases
At the link with the obstruction of the microflora of the upper dichny paths and the empty company, put the sputum on the middle dwellers, including during the last few visits (retreat), rinsing with the weak, etc. The informativeness of the sputum sputum seed grows when the best method Doslidzhennya: visions of microorganism vvazhaєtsya ethiologically significant at its concentration in phlegm 106 microorganisms in 1 ml. bacteriological design anaerobic infections tied with significant methodical difficulties and leave small numbers of medical installations.

Oglyadova radiography of the organs of the breast. We are guilty of being destroyed at once and all we have ailments with adolescence on pleurisy rate and, especially, on pyopneumothorax. You will be allowed to establish the localization of the pathological process, by the number of steps in the interconnection of the exudate (vilne volodinnya or embedment), as well as precisely due to the importance of this process. When analyzing radiographers (as it is not a doctor-radiologist), it is necessary to show respect, in addition to the darkening of the lung tissue, for all the hemitorax, the appearance of emptyness in the lung during the early life, on the occasion of the health of the middle in the pleural emptying and / or middle hemphysema, the adequacy of the drainage standing (even if the supply is on the anterior stage). For an accurate determination of the size of the emptying of the emptiness, of the configuration, the number of stinoks (the region, the manifestation of fibrinosis), as well as the verification and clarification of the localization of the bronchopleural disease, the possibility of For carrying out in the pleural empty space, 20-40 ml of watery contrasting speech is injected through the drainage.

Computer tomography of the organs of the breast... Allowing to change the character of the lung damage, which became the cause of pleurisy, because of the localization of osumkovaniya (for a given vibration, to the method of draining), and the appearance of bronchial mucus fistula. Multispiral computer tomography by the most advanced method of verifying chronic pleural tempo. With the presence of pleurodermal fistula in ailments with a chronic rate in a row of symptoms in the course of an hour of computer tomography, the diagnosis of fistulography is done.

Ultrasound of pleural emptying... It is necessary for the value of the point for a safe and adequate drainage of the pleural emptying in the case of the presence of confinement.

Diagnostic puncture of pleural emptying... Є residual by the method of verification of diagnosis. Otrimannye vmestu pleural emptyness is allowed to vvvazhy Mozhlivny diagnosis of pleurisy is absolutely reliable. Viconuvatsya in the presence of clinical and radiological signs of pyothorax and pyopneumothorax. Exudate is sent to cytology, bacterioscopic and bacteriological dosages (from the sensitivity of flora to antibiotics). Signs that indicate about suppurative parapneumonic exudate є: positive smears-vipotas for bacteria, pleural glucose less than 3.33 mmol / l (less than 0.4 g / l), injecting a vip for bacterial culture positive, pH 7 20, LDH vipotus 3 times higher than the upper limit. In a number of vipads in the exudative stage, a differential diagnosis is required between transudate and exudate. For the whole it is necessary to replace the bottle in the pleural region. It’s enough, because a sick person has a blood level in the norm, and instead of a blood level in the pleural area, less than 25 g / l (transudate) or more than 35 g / l (exudate). In the first situations, the criteria of Light are victorious.

Pleural ridina є eksudatom, if there is one or more of these criteria:

blood count of pleural origin and blood count is more than 0.5;
blood lactate dehydrogenase and blood lactate dehydrogenase development is more than 0.6;
lactate dehydrogenase of the pleural origin changes 2/3 of the upper boundaries of the norms of lactate dehydrogenase of the blood.

fibrobronchoscopia... Perelіduє kіlka goals: due to the presence of draining bronchus, which is the cause of the empієmi є abscesses of the legacy; viklyuchiti central cancer of the legacy, Frequently, pleural carcinomatosis (cancerous pleurisy), which is transformed into pleural tempo in the event of an inflamed exudate; to receive promising bronchial water for the establishment of a microbiological agent and the selection of rational antibacterial therapy; to carry out the sanation of the tracheobronchial tree in the presence of a destructive process in the legends. Slid vrahovuvati, which snakes from the bronchial tree, captured during bronchoscopy, are practically contaminated. The informativeness of the material acquired during bronchoscopy is often developed with the help of the advanced method of advancement: visions of microorganisms become ethologically significant with the concentration in the bronchial microorganisms.

The information can be discarded by combining bronchoscopy with the introduction into the pleural emptying by the drainage of the volume of the peroxide in addition to 3% peroxide (retrograde chromobronchoscopy). Due to the fact that the de penny barvnik enters into the education of the subsegmental and segmental bronchial tubes, it is possible to precisely determine the localization of the bronchopleural condition. In some cases, information about the localization of a bronchopleural fistula can be eliminated with selective bronchography by means of the introduction of a waterborne contrast speech through the fibrobronchoscope canal, inserted into the zonal bronchus, with a one-hour X-ray imaging. In case of adolescence for the appearance of bronchodilator fistula, it is necessary to visualize the contrasting fluoroscopy of the duct and fibroesophagoscopy.

Prescription of the function of the international community... There is a lot of self-determination that is more practical. May be it’s okay when the show is set up before the operation chronic stage zahvoryuvannya for the designation of functional reserves of the lungs and portability of the operation.

videothoracoscopy... Є by the method of diagnostics and treatment of pleurisy, rather than pershoi cherga. You will be able to assess the nature and extent of the gnarly-destructive process in the lesions and pleurisy, the stage of the ignition process, in the presence of localization and development of bronchopleural fistulas, as well as, but not less importantly, adequately control the drainage of the pleurisy. Stagnate in the stage of exudative and fibrinous-gnine with ineffectiveness of simple drainage of pleural emptying (with the manifestation of encapsulation and non-rational drainage). Videothoracoscopy can be supplemented with elements of operations (debridement).

Lіkuvannya empієmi pleurisy

When a diagnosis of pleurisy is established, a hospitalization of the patient is required before a special medical examination of the patient (due to the blame of the patient due to the established tuberculous ethology). With a large number of patients with pneumothorax, sepsis, hypovolemia, heart-vascular and dysfunctional deficiencies, one should be hospitalized for the purpose of reanimation and intensive therapy. In the case of pleurisy rates, it becomes conservative, as well as operational methods, as it stays in parallel one to one, starting from the earliest stage of the process.

Operatively, it can be of a palatal nature (drainage of pleural emptying, video-thoracoscopic sanitation and drainage of pleural emptying), as well as a radical nature (pleurectomy, decortication, resection of the legacy). The vibe of that chi іnshogo operative involvement in the beginning of the stage of pleurisy (eksudative, fibrinous-gnіine, scho to be organized), the heavy camp of the patient, the main pathological process in the lung, which is early inoculation before

By the method of elimination of pleural effusions, a stage of elimination of rapid emptying as a result of the formation of intermeshed pleurodesis (fibrothorax), does not impair the function of the invoking dichotomy. For a person it is necessary to immediately see the low tactful employees:

visible pus and sanitation of empty empty space;
expansion of the lung (elimination of the empty empty space);
suppression of infectious diseases;
korekts_ya porushen to homeostasis;
detection of pathological processes in the lung, ribs, sternum, other organs, as well as information about pleural emptying.

Falsely from the stage of congestion (exudative, fibrinogenic, organisation), the development of skin care will be healthy (Klopp M. Et al., 2008). At the same time, in the foreign literature, there are recommendations from the school II and III stage from the position of scientific-grounded medical practice. The results are prospective and randomized until they clear up.

Lіkuvannya empієmi pleurisy in the exudative stage.

Daniy zakryd can be used as a single and residual method of treatment in a number of vipads (“close” of the rate of pleurisy, rate of pleurisy with a slight amount of bronchopleural occasion), as well as a preparatory stage until inevitably promptly. The visible pus and sanitation of the pleural emptying can be reached in two ways - puncturing the pleural emptying and "closing" drainage (thoracocentesis). For an additional point, a grunt was taken of the closed pleurisy, a small amount (less than 300 ml), or exudative pleurisy, the ears were transformed into a new, without significant number of fibrinous pleural effusions on One punctual method is the most effective in case of elimination of tempo, which is localized in “important” types of hemitorax - apical, paramedial, paramedial, supraphragmatic, interlobar.

With a punctual method of cleaning up emptying, it is necessary:

I will be able to aspirate instead of emptying when skin puncture;
sprinkle the empties with an antiseptic to a clean sprinkle. At the same time, an obsyag of a one-time introduction is not guilty of overhauling an evacuated one with pus (for a loss of growth and information on the appearance of a pleural emptying);
when the emptying is installed in the maximum capacity;
to introduce into the empty space in front of the knights of the golki I will add a dose effective antibiotic(Bactericidal, wide range before discarding the results of bacteriological dosage) in a small amount of antiseptic (10 times less, less empty).
in case of manifestation in the expulsion of plastics, for example, in the form of a fibrinolytic agent, as a result of the transfer of aspirations, in the warehouse, it is necessary to add a fibrinolytic drug to the empty place.

Punctual sanitation can take no more than 7-10 days; the item will be held every day. The criterion for the effectiveness of puncture sanitation of emptying is to serve as a quick way of eliminating the manifestations of intoxication, reducing the amount of empty people (expansion of the lung), reducing the rate of accumulated exudate and transformation of serous disease into serous At the same time, there is a decrease in the amount of leukocytes (not more, less in the peripheral blood, the increase in lymphocytes instead of up to 5-15%), and with bacteriological pre-growth, it does not develop.

Prototypes to the point-by-point method є The rate of pleurisy is significant (1-1.5 l), as well as the manifestation of bronchopleural damage, including the occurrence of bronchial mucus fistula (it is unwise to aspirate instead of the pleural emptying, to correct the repair)

In a large number of cases with pleurisy in the way of seeing pus and sanitation of pleural emptying, it is stagnant, so called close drainage (thoracocentesis). The amount of manipulation can be of the nature of non-practical aid (stress of pneumothorax, total pace of pleurisy due to changes in the organs of the middle). In case of "overcritical" rates of pleurisy, the drainage method of sanitation is often a residual method of treatment.

At a time when the drainage of parapneumonic pleural vapors is not primed, it may itself be the cause of the rapidity, while keruvatis is shown before the drainage of pleural emptyings, proponated by the American College of Physicians - American Society of Internal Medicine and Infectious Diseases. . et al., 2006):

symptoms of bacterial pneumonia and pleural effusion;
temperature below 380 С;
leukocytosis more than 11x109 / l;
gnіyna sputum;
PLEURITAL chest b_l;
Infiltrate radiological;
encapsulation of pleuralvipit;
The pH of the pleural vipot is less than 7.2;
in the pleural emptying;
positive seeding to vipot.

When the pleurisy is closed, the principle of emptying sanitation is not considered as described in the case of punctual control. Doubtlessly, two-lumen tubes are victorious, and when there are no more obvious materials (introduced into the lumen of the “main” tube of a thin catheter). Do not allow to continuously drain the drainage tube and to obstruct it with detritus and fibrin. For the development of the development in the pleural empty space, the growth of the growth of the annexes (pleuroaspirators) with the permanent growth in the pleural empty space is 40-60 cm of water. Art. It is not possible to facilitate the expansion of the lung with a passive discharge of pus from the pleural emptying.

The pleural emptying is guilty of being carried out in a fractional way 2 times a day: through a thin opening of the drainage with a closed wide one, a drop of antiseptic is injected (as a result of a large amount of empty waste), in order to get a widespread drainage. Vikoristovuєtsya zvychay up to 500-1000 ml of antiseptic solution. Every day, in the bandaging process, there is emptying for the additional syringe Janet, at the same time, there is a passage of drainage, stability of the vacuum in the pleural empty space, a mill of soft tissue in the circumference of the drain. At the end of the emptying process, antibiotics are introduced into it, the drainage is curved for 1 1.5 years.

Sanation of pleural emptying in case of acute (with bronchopleural) rates of pleurisy, there are a number of peculiarities. In the extreme, the value of the drainage (polypositional fluoroscopy or ultrasonic monitoring) and the introduction of drainage. The drainage tube is guilty of being inserted into the lower empty waste, so that an overlap is accumulated below the drainage tube (when the empty tube is closed, it will “see” into the drain).

The emptying process is guilty of doing so, so that I do not suffer aspirate pneumonia before the hour I enter the gap in the Legenev fabric (on the side of the battle and the antipathy). For the whole obsyag of the industrialist, he is guilty of picking up individually (not coughing), and the promiscuity is guilty when the sick person is sick. Rivn of growth in the pleural empty in the cob period is guilty of the other minor (5-10 cm of water. Art.), ). The process of sealing defects in the leg tissue, when I openly tear small subcortical abscesses into the pleural empty space, for example, if the lung is punctured, drained (iatrogenic pyopneumothorax).

About the efficiency of drainage to reduce the expansion of the lung, which is more likely to be observed in case of x-ray dosing (without the need for a drain, on the next step, and then 1-2 times for a day). Drainage of a great number of plastic fibrin to serve as a guide for suction of intrapleural fibrinolytic therapy (Sahin A. et al., 2012). They are indifferent to those from a formal point of view, in the context of the presentation of fibrinolytic therapy - the stage of fibrinous-gnіine, a little more early signs before the appearance of pus, so that the stage is exudative, even in the pleura. Fibrinolytic therapy allows a reduction in the rate of drainage of pleural emptying, a faster normalization of the temperature, up to 3 days of success in 86.5% of patients and, of course, the frequency of these changes is 13.5%. Intrapleurally 250,000 OD of streptokinase or 100,000 OD of urokinase per 100 ml of physiological growth is injected. A preliminary assessment of the two preparations showed the same efficiency (92%) at a lower frequency of acceleration in case of vicious urokinase and less economical vitrates in case of vicious streptokinase (Bouros D. et al., 1997). Є more recent information about the intake of deoxyribonuclease (Simpson G. et al., 2003).

With a change in the amount of exudate (up to 30-50 ml for extra), the amount of the rinse rose introduced into the empty container will change. A visual drainage is carried out for a repeated release of the drainage, so that pleurography occurs (the introduction of a contrasting speech does not expand along the pleural emptying), and in some cases when the drainage is depressurized (it does not fall easily). Tse sposterіgaєtsya, as a rule, after 1-1.5 tizhnі lіkuvannya. Obligatory X-ray and ultrasound control for visible drainage (it is not easy to accumulate exudate in the bed, which is the reason for the recurrence and the formation of a "encapsulated" rate or suppuration of the drainage canal). In case of manifestation of a pleural puncture, a pleural puncture is required.

Vіdsutnіst efekt od Closed-drenuvannya plevralnoї porozhnini (zberezhennya klіnіko-Find our laboratory іntoksikatsії, lihomanki, nezmenshuvanogo gnіynih vidіlen of plevralnoї porozhnini) protyagom 2-3 dіb guilty Buti drive for zastosuvannya vіdetorakoskopіcheskoy sanatsії plevralnoї porozhnini (Pothula V., Krellenstein DJ, 1994; Hecker E ., Hamouri S., 2008).

The spreading of the lung can be reached at once from the visitor of the first zavdannya shlyakh vydalennya syringe Ridini "all the way" or post-vacuum aspirate on drainage. With localization of bronchopleural damage in the boundaries of one part of the velmy effective method lіkvіdatsії yogo є timchasovaya obturation of the pyocytic or segmental bronchial tubes (timchasovaya valve on bronchial blockages). Special foam bronchial obturator and valve bronchoblocker are delivered to the zone of installation behind an additional fibrobronchoscope, or in case of severe subanesthesia bronchoscopy. Unimportant on the decrease in lung lightness in the occlusion zone, the sealing of the bronchopleural appearance, allowing for the distribution of the lungs for the opening of the ventilated airways, for the diaphragms. In deyakikh vipadkah, dozіlno overlay pneumoperitoneum.

As the airtightness of the rapid emptying was renewed after 2-4 days, the valve of the bronchial blocker can be overstretched for 2-4 hours (an hour, necessary for the development of mooring, as it is easier to move to the chest wall). Over the course of an hour, the endobronchitis develops in the occluded part of the lung (the so-called postocclusive syndrome). However, it’s quick to buy a bronchoblocker. For lightness renewal, "plugged-in" legacy can be visual drainage. In vipads, if the endobronchial occlusion appears to be an ineffective stretch (with localization of bronchopleural fistulas in sumy parts), the progression is insufficient.

The occlusion of the head bronchus is flexible, however, the development of important distortions and the development of the migration of the foam obturator with the development of asphyxia. An alternative way of "switching all the legends" can be the setting of 2-3 occluders in the parts of the bronchi. The installation of a valve bronchoblocker in case of fistula of the head bronchus during pneumonectomy may not be feasible due to the small size of the mucus itself. Adequate drainage plevralnoї porozhnini i її sanatsієyu at "vіdkritoyu" empієmі pleura guilty obmezhuvatisya lіkuvannya ailments in zagalnohіrurgіchnih statsіonarah, oskіlki spetsіalnі hіrurgіchnі way to lіkvіdatsії porozhnini at Tsikh kinds empієmi mozhut provoditisya tіlki in spetsіalіzovanih Set (torakoskopіchna sanatsіya porozhnini of "plombuvannyam" bronhіalnih svischіv, timchasova endobronhіalna occlusion abo valve bronchoblocks, lymphocytic pneumoperitoneum).

Vibir of antibacterial drug for empirical therapy begins to etiologic structure of the rate, as to lay down among the peculiarities of the disease. Empієma, associated with pneumonia (with an abscess of the lung, or without it); empієma, associated with abscesses of aspіratsіy genesis. The main microorganisms є anaerobes (Bacteroides spp., F. nucleatum, Peptostreptococcus spp., P. niger), often in some of the enterobacteriaceae, are often accompanied by the asp. aureus. In general, with Vibor drugs: ingibitoroprotective penicillin (amoxicilin / clavulanate, ampicilin / sulbactam) in combination with aminoglycosides III generation(Amikacin) i / abo with metronidazole; cephalosporin III generation in combination with aminoglycosides III generation. Prior to alternative drugs, there should be: the seizure of cephalosporin III generation (cefoperazone / sulbactam) in combination with metronidazole; cephalosporin IV generation (cefepim) in combination with metronidazole; respiratory fluorochinoloni (levofloxacin, moxifloxacin) in combination with metronidazole; carbapenemi; vancomin, linesolid (only when primed with a high rhizik MRSA).

Empієma, associated with gangrene of the legend... The main microorganisms are anaerobes (Bacteroides spp., F. nucleatum, Peptostreptococcus spp., P. niger), Ps.aeruginosa, Klebsiella pneumonia, Staph. aureus. In general, with Vibor preparations є: cephalosporin of the third generation in the second generation with aminoglycosides of the third generation and with metronidazole; respiratory fluoro-chinoloni in addition to aminoglykozidmi III generation and metronidazole. Prior to alternative drugs, there should be: IV generation cephalosporin in addition to vancomycin (aka linezolide); carbapenemi.

Empієma associated with septic abscesses... The main cultivars are Staphylococcus, including MRSA (for intravenous sepsis), Enterobacteriaceae, Str. pneumonia, Enterococcus spp., Pseudomonas spp. In general, with Vibor drugs: cephalosporin III-IV generation in combination with metronidazole; respiratory fluoroquinoloni in combination with metronidazole. Prior to alternative drugs should be: vancomycin in combination with carbapenems; Lenesolide in combination with cefoperazone / sulbactam.

Empієma post-traumatic and pislyaoperatsіyna... The main culprits are є Staph. aureus, Str. Pneumonia, H. influenza. In general, with Vibor preparations є: cephalosporin III-IV generation. Prior to alternative drugs should be: vancomicin (monotherapy).

The empima is rotten, as well as the appearance of bacterioscopic results in the growth of microflora when... In many situations, the ethological role of anaerobes and / or gram-negative enterobacteria has been developed. Vibor preparations є: Ingibitoroprotective penicillin (ampicilin / sulbactam, amoxicilin / clavulanate); Ingibitoroprotection of cephalosporin III generation (cefoperazone / sulbactam). Alternative drugs є: cephalosporin III-IV generation in combination with metronidazole; linkosamidi (clindamicin) in combination with aminoglycosides of the third generation.

Vibrating the drug will be able to respond individually to the appearance of a visionary and sensitiveness. The triviality of therapy starts individually (you can reach 3-4 times). Introduced antibiotics: internal, internal. In this hour, I did not feel the overwhelming tribute in the re-entry of the regional artery (in the Legenevian artery, the test of angio-pulmonography, or in the bronchial artery, the test of the aortography and the selective bronchial artery).

Correction of homeostasis, viclikanikh development of gn_y zapalennya.

A keen eye for the ailment; when smelly sputum is seen, it is bazhano izolyuvati sick.
She is guilty of being profitable, caloric, and fortunate enough to have a number of new wine and vitamins. In case of a deficient nutritional status, it is necessary to recognize additional food intake (unbalanced livelihoods).
Renovation of the main hemodynamic parameters (reduction of the BCC to the vascular bed), stabilization of hemodynamics. For the whole family of obov'yazkov, insertion of a clavicle catheter for trivial and massive infusion therapy in the most important ailments (it is important to introduce a lesion on the side to reduce pneumothorax on the “healthy” side). For the prevention of thrombophlebitis and angiogenic sepsis, it is necessary to look after the catheter.
Podtrimka energetic balance: the introduction of concentrated solutions of glucose (25-40%) with the obligatory addition of insulin (1 unit for 4 g of glucose).
Korektsiya electrolyte balance: Polyurethane solution, for revealing salts with calories, magnesium, calcium, etc. Assigned solutions should be injected in 1-3 liters per addition in the fallow area from the camp of the sick.
Updating the alcohol balance (in the range of not less than 40-50% of the additional consumption) for the additional range of amino acids (polyamin, panamin, aminosteril, Aminosol, Wamin and in.). In case of hypoalbuminemia, it is recommended to inject 200 ml of albumin 2 times per day. In addition to parenteral feeding, you can make sure that the body is not less than 7-10 g of nitrogen and 1500-2000 kcal / dobu. The preservation of nitrogen is introduced to increase with the one-hour introduction of anabolic hormones and vitamins. Criteria for the recognition of nutritional supplementation: deficiency of oil content more than 10%, index of oil content less than 20 kg / m, hypoproteinemia (instead of overgrowth alcohol less than 60 g / l) or hypoalbuminemia (albumin 30 g / l).
Decrease in high proteolytic activity of blood supply (especially with gangrene and unpleasantly penetrate abscesses): Ingibitori proteases (counteracting up to 100,000 units / dob).
Protisapalnaya therapy: 1% solution of calcium chloride internally, 200-300 ml 2 times per day.
Renewal of the immunological reactivity of the sick person in the state of the period: immunotherapy in the case of repeated transfusions of antistaphylococcal plasma, antistaphylococcal gamma globulin, immunoglobulin G, immunoglobulin immunotherapy, immunoglobulin immunotherapy
Microcirculation in the ignition zone: trental, heparin (non-fractionation, low molecular weight), cryoplasma anti-enzyme complex according to E. ATseimakh and Ya.M. Shoikhet (2006): plasma is freshly frozen 800-1000 ml, contrikal 80000 - 100000 OD 3 times for dobu, heparin 5000 OD 4 times for dobu or low molecular weight heparin in drug doses.
Correction of hypoxemia: kisen.
Correction of anemia (behind shown): transfusion of erythrocyte mass, frozen erythrocytes.
Extracorporeal detoxification: plasmapheresis, low-flow hemodiaphiltraction (only with adequate drainage of pleural emptying and all accumulation of mucous membranes without bacterial-toxic shock).
Advancing nonspecific resistance to organisms: extracorporeal ultraviolet optimization of blood, ozone therapy.
Likuvannya of heart failure: heart glucosidi, euphilin, cordiamin.
Respiratory pidtrimka: dose, oxygen therapy is controlled; CPAP-therapy (without interruption a positive grip in spontaneous paths with spontaneous dichanna); non-invasive mask ventilation; invasive ventilation: primus, kerovana, controlled (controlled by Volume Control and Pressure Control); modes of additional invasive ventilation (VIVL); spontaneous response: T-tube, oxygen therapy, atmospheric nutrition.

Lіkuvannya pathological processes in the lung, ribs, sternum, іnshih organs, scooped up the information of pleural emptying. With regard to the most significant etiological significance of pneumonia and abscess of the lung, go to the first plan of guilt, directing to the maintenance of optimal drainage of destruction in the lung through the bronchial tree. Changes in calls and methods of detection are guided by the current National Clinical Recommendations.

Lіkuvannya empієmi pleura in the fibrinous-gnіine stage.

Evidence of pus and sanitation of empty empties... The imperfection of the residual power of the "closed" drainage is less, lower at the forward stage, to navigate behind the mind of the "closed" pace. It will be effective only on the very cob of the fibrinous-ganglion stage (Ferguson M.K., 1999). Draining the pleural empty space extra help for decompression of hemitorax with the help of other video-and-thoracoscopic medical procedures. Trivially try sanitation through the installation of "naoslip" drainage is wrong, especially in the presence of bronchopleural fistula. It is necessary to show earlier than vistavlyaty before vidothoracoscopic sanitation with targeted installation of drains for flow-through cleaning (Pothula V., Krellenstein D.J., 1994). Vidothoracoscopic sanitation will be effective only at the earliest possible stagnation at the stage (Wait M.A. et al., 1997; Klopp M. et al., 2008).

Fibrinous-gn_yna stage with multiple encapsulation of video-assisted thoracic surgery (VATS). It was patched at the early stages of the fibrotic stage, the decor of the tissue is allowed in the decor of the so-called "debridement" ., 1993; Landreneau RJ et al., 1996; Hecker E., Hamouri S., 2008; Klopp M. et al., 2008).

For a number of ailments, the installation of drainage does not cope with its function due to the peculiarities of the main ailment. Before them are known: gangrene of the lung and erupting lung abscess with sequestration (the appearance of great sequestrations and non-rejection of necrosis of the lung, rotten rate), great defects in the lung tissue of the breast, Intoxication, post-traumatic rate of pleurisy due to traumatic injuries. In such situations, the perevagu goes to the so-called "open" drainage rate. Vykonutsya mintorakotomy from resection 1-2 ribs from the edges of the shkiri to parietal pleura (fenestration of the chest wall, thoracostomy, thoracoabscessostomy).

With an important mindset of the operation, the visibility of the interconnection (mooring) between the visceral and partial pleura in the zone of destruction. Zvvychay such moorings to form in 1-2 tiznі from the cob to become ill (to the extent to the cob of fibrinous-gnіynoi stage) and appear clearly with computed tomography. In general, in the event of a thoracotomy, a total collapse of the leg can be caused by important dysfunctional discharges, and the need to seal the empty wastes for the purpose of producing a good sanitary efficiency.

Radikalnі hіrurgіchnі vtruchannya for Relief thoracotomy (plevrektomіya, decortication, in addition chislі of Lobektomіya, Pnevmonektomіya) in qiu stadіyu zahvoryuvannya povinnі zastosovuvatisya on Duzhe Suvorov indications: sepsis of narostayuchoyu іntoksikatsієyu i polіorgannoї nedostatnіstyu at blokovanomu abstsesі abo gangrene, nezvazhayuchi on drenuvannya plevralnoї porozhnini i Intensive treatment, including methods of extracorporeal detoxification. The problem of such operations is associated with a bacterial-toxic shock, technical accelerated infiltration of the lung root, and a risk of bronchial mutilation in the brain process. In addition, in the time of the torpid current of the rate of bronchopleural fistula, decreased muscle and zagalny immunity, the transition was later seen as a sanitary videothoracoscopic in hand, including those shown by T.

Expansion of the lung (elimination of the empty empty space)... Expansion of the lung, as in the case of elimination into the exudative stage, can be reached instantly from the first run of the path of continuous vacuum aspiration for drainage. With localization of bronchopleural appearance in the boundaries of one part of the velma, the flock is shown to be valve bronchoblocking. Unimportant on the decrease in lung lightness in the occlusion zone, the sealing of the bronchopleural appearance, allowing for the distribution of the lungs for the opening of the ventilated airways, for the diaphragms. The elimination of bronchopleural activity allows more energy to sanitize the pleural emptying (there is no need for aspirations of the industrial growth).

Suffocation of infectious diseases... At the fibrinous-genital stage, antibacterial therapy, which will also have the character of ethiotropic (direct to a specific child), is used to discard the results of microbiological dosage. It is possible to change the antibacterial drug on the basis of microbial resistance or dose correction.

It is carried out in accordance with the principles of viciousness. It is possible to get good treatment in the warehouse of infusion therapy, as in case of increased strength (with an increase in intoxication), as well as in case of change (in case of increased anabolism over catabolism).

Likuvannya pathological processes in the lung, ribs, sternum, and other organs, as well as the information of pleural emptying. Triviality in the main pathological process.

Lіkuvannya empієmi pleura in the stage of organizing.

Evidence of pus and sanitation of empty empties... Until the moment of the transition to the stage of organizing on the basis of emptying, there is a tendency for the drainage to be cleared; With a successful interruption to the process, the process can be completed without emptying. In the whole range, go to the empty room to clean up the empty space and put the antiseptic through the drainage until the empty waste is cleaned and the drainage is visible. A visual drainage is carried out for a complete drainage, so that pleurography occurs (the introduction of a contrasting speech does not expand along the pleural empty space). Tse sposterіgaєtsya, as a rule, after 2-3 years of pregnancy. Obligatory X-ray and ultrasound control for visible drainage, as it is not easy to accumulate exudate in the bed, which is the cause of recurrence and the formation of a "encapsulated" rate or suppuration of the drainage canal. In case of manifestation of a pleural puncture, a pleural puncture is required.

With a trivial, torpid interruption, tied with the appearance of a bronchopleural fistula, a decrease in the muscular and spinal immunity, the emptying does not insist, є it is not necessary to keep dropping off the drain, and do not drain the drain. According to the terms of prices, the period is 1-1.5 months. Actually, I’m talking about the formulation of chronic empires (in the traditional word for vichiznyanoy medicine). It is uncommon for such patients to be brought to the house with drainage for a day, having in advance introduced their own self-care, and after 2-3 months they will be able to perform a radical operation for the additional thoracotomy.

I'm going to let the group become patients, who needed to re-use the already formed chronic rate of pleurisy for a planned radical operation. If they have an emptying rate, they have a functional (including drainage) pleurodermal fistula due to signs of a systemic ignition reaction syndrome. Tse reach by way of emptying through earlier installations of drainage or drainage installations, based on the data of computer tomography or ultrasonic monitoring. Otrimannya vіdіlennya to go to bacteriological advances, the results of which will be significant when choosing an antibacterial drug during the operation. For short-hour training, the decision is made about radical surgical involvement behind the addition of thoracotomy.

Expansion of the lung (elimination of the empty empty space)... It is uncomfortable to distribute the lungs to the extent of the sclerotic process in the compromised part of the lung (pneumofibrosis, pneumocyrosis, fibroatelectasis). Patients are shown thoracotomy.

Suffocation of infectious diseases... At the organizuyuch stage, infectious processes in the emptying of the compartment, or the concentration of microbial objects, does not add up to the clinical picture due to the interconnection of the emptying with a fibrous capsule. This systemic antibacterial therapy can be pinched. If a patient is sick with a chronic pace for a planned radical operation, an empirical antibacterial therapy before the operation is preoperative if there is a manifestation of the systemic ignition reaction syndrome in a short course in the process of preoperative preparation.

Correction of homeostasis, viclikanikh development of gn_y zapalennya... With a disagreeable relocation of the disease, the transition to the organisation stage is to indicate the change in the pathological inflow to homeostasis. This can only be provided with corrections of damaged functions and safety systems. Hvory, we hoped for a planned radical surgery, correction of homeostasis in the preoperative period, the guilt was corrected for hypoproteinemia, anemia, hypocalypsemia, hyperammonaemia, serum percephalitis

Lіkuvannya pathological processes in the lung, ribs, sternum, іnshih organs, scooped up the information of pleural emptying. The nature of the treatment of compromised organs (legs, ribs, sternum) is followed by the treatment of radical involvement (expansion of radical operations).

Vibir to the method of surgery in case of pleurisy in the stage of organizing in a planned manner... The main staff of planned radical surgery for ailments in the stage of organization є: fixing bronchopleural conditions, liquidation of surplus emptyings. Obsyag radikalnoї operatsії bude zalezhati od etіologії empієmi, nature poperednogo vtruchannya easy to i grudnіy klіttsі, obsyagu porozhnini empієmi, will legenevoї parenhіmi, nayavnostі bronchopleural fistula, cerebral nayavnostі nespromozhnostі Cooksey abo chastkovogo bronchus tyazhkostі will patsієnta (dekompensovanі suputnі zahvoryuvannya zhittєzabezpechennya systems). Surgical access to the whole stage - only thoracotomy.

Patients with parapneumonic rate, as well as rate of abscess and gangrene of the lung, suppuration of pleurisy and hemotrax. In case of intercourse in patients with non-operative ailments (including bronchopleural fistula) and preserving the legenevia parenchymal vikoristovuyu decortication of the lung (being able to moor from the visceral pleura). The negative aspect of the operation is to preserve the parietal mooring - the real dzherela of reinfection of the pleural emptying. In case of subtotal and total emotions, meaningfully collaborating with the lung, but obviously preserving the parenchymal lesions, plerectomy is shown - the visceral and parietal mooring at the viglyadi of the same pulmonary. With the presence of bronchopleural fistulas and a compromised lung (chronic abscess, fibroatelectasis, pneumocyrrhosis), it is normal to reexpansion, and also in connection with the great intraoperative cases of enlargement of the lungs,

Patients with chronic episodes of operative emptiness due to fistula of the great bronchus. In such situations, an opsyag operation is found in the localization of the bronchial fistula. In case of fistula of a kuksi partial bronchus, a pre-anterior lobectomy offending occurs immediately after a planned radical operation - a "residual" pneumonectomy with plerectomy occurs. With the presence of a fistula of the head bronchus, pneumonectomy vibrates in the way of the first time, it starts with a new type of solution, that is, there are options for treatment. If the computer tomography is given the data of the computer tomography, it becomes 1.5 cm, then the transition will go to the trans-sternal transpericardial resection of the kuksi. If you dovzhina kuksi mensch 1.5 cm, then put the stitching device on such a stump, it is unlikely that it will go out. At the ligament of the cysts, it is possible to create a transthoracic (behind the aid of thoracotomy) myobronchoplasty from the rotational valves of the widest spine or omentobronchoplasty from the great omentum to save the blood flow (1989). Perevaga vicorystannya of the great omentum was tied with that, as a result of the anterior pneumonectomy due to the drive of gangrene of the lung during the thoracotomy, the judges and the nerves of the widest spine of the back were recalculated, which called up to the hypotrophy.

Є Regarding the introduction of autologous stubbrow mesenchymal cells by means of a path around the norepine opening before the hour of fiberoptic bronchoscopy (Gomez-de-Antonio D. et al., 2010; Petrella F. et al., 2015). In any case, closing the bronchopleural fistula can overwhelm the residual emotional response (Ferguson M.K., 1999). If, as a result of all successful visits on the elimination of the fistula of the head bronchus, it will be taken out of the empty space, then in another step (added) one type of thoracoplasty is carried out.

vidi thoracoplasty... thoracoplasty - surgical involvement When you see a part of the ribs, you yourself will get rid of the mobilization and retardation of the chest wall. Meta operation is a liquidation of excessive emptying by a pacemaker, most often because of pneumonectomy, because it is not easier to get re-recovery, because it is unhealthy to investigate the operation of decortization and pleurisy. All methods of thoracoplasty are divided into 2 groups - intrapleural and extrapleural. With interpleural thoracoplasty, there is a wide opening of the empty space in the pleura, with a wide appearance of the ribs with intercostal cuts and prismatic pleural scars (thoracoplasty according to Shede). Naybilsh often zasosovuyut descend thoracoplasty according to Limberg. Above the empty empty space, there are slightly more ribs and through the bed to pass parallel one to one late risers. Once the rosette of the bed of the resected ribs was made, the soft fabrics are cut in front and back (by the way) and re-created into the stems from the back or front lower. They put the stems on the bottom of the empty empties and settle there for an additional tamponade. Tim himself is empty.

Dodatkovo to thoracoplasty can be purchased from vikoristan omentoplasty. With Extrapleural thoracoplasty, a subperiosteal resection of the ribs is performed, the ale-pleural emptying does not open, and the west chest wall will prevent compression and collapse of the leg tissue. Velikі torakoplastіcheskіe operatsії for lіkvіdatsії stіykoyu zalishkovoї porozhnini at hronіchnіy empієmі pleurisy in danii hour zastosovuyutsya rіdko, oskіlki rezektsіya 8-10 ribs travmatichnostі not postupaєtsya pnevmonektomіі and vіddalenі naslіdki (rozvitok tsiroz legenі, formuvannya "legenevogo sericite" progresuyucha dihalna nedostatnіst) vazhkі. Interchangeable thoracomyoplastic operations (three-ribbed, five-ribbed) reach widely stagnated in a given hour. The essence of the operation of the polyaga is in the resection of 3-5 ribs over the tempo and tamponade of the sanitized empty piece with a valve on the bottom (one of the great ligaments of the chest wall).

Paliativny operatsii in chron_empієmi... Sometimes we are sick of the chronic pace of being brought to a palatial operation - thoracostomy with an empty pleural empty space. Dane vtruchannya vikonuєtsya patsієntam of hronіchnoyu empієma pleura pіslya lobektomіya i pnevmonektomіі at bezperspektivnostі traumatic radikalnoї operatsії (lіkvіdatsіya fistula torakoplastіka, torakomіoplastіka) at relapse puhlini, Wkra nizkih pokaznikah funktsії legen, sericite i nirok i in yakostі palіativnogo come in scho polegshuє doglyad for porozhninoyu.

With the help of additional help, we can not get sick from pleurisy:

install drainage in the pleural empty space in patients with a transudate and a small (clinically insignificant) exudate in the pleural empty space without vagomich for those who need to unify this information and development of the rate;
to tighten the term of simple drainage (drainage, deliveries "onoslip") for more than 3 days, as the toxicity and gnіinevidokremlyuvanne drainage does not change;
support on the shvidka and povnotsinne expansion of the lung with a passive discharge of pus from the pleural empty space;
prodovzhuvati timchasovu endobronchial occlusion of the bronchopleural fistula is more severe, as the term is not effective;
to visualize drainage from the pleural empty space (for a friendly overloading) without radiological and ultrasonic monitoring of the empty frame and distribution;
vikonuvati "see" drenuvannya empієmi (fenestration of the breast, thoracostomy, thoracoabscessostomia), not having a taste of the visualization of the interstitial growth (mooring) of the fenestration of the thoracostomy;
transferring the examination of a planned radical operation to the exudative stage and into the organisation stage in connection with the risk of bacterial-toxic shock, intraoperative technical acceleration in cases of infarction of early bronchitis, early bronchitis
vikonuvati in the external surgical hospitals of special surgical methods of eliminating emptying in case of "open" emptiness (thoracoscopic sanitation of emptying from the "filling" of bronchial ligaments)
pragmatic in all cases, excessive emptyings were formed before the "chronization" process (ailments from excessive emptyings in the pleural emptyings larger than 5-8 cm, pleural drainages and active pleural-pleural norits).

forecast

Slid clearly identify the possible options for the result of the pathological process. Somewhat trivially, the abdominal process in the pleura is susceptible to bending the mesothelial ball of the pleura and scarring degeneration, that is "restitutio ad integrum" In such a rank, skinning with pleurisy means the suppression of a gross ignition process in the pleural emptying and removal of the formation of cicatricial growths between the thoracic and leguminous surface.

However, the elimination of emptying by such a path does not expect a successful outcome of the disease. Nezvazhayuchi vіdsutnіst to drain for relapse gnіynogo broken-winded in oblіterіrovan porozhnini, nerіdko sposterіgaєtsya utvorennya nadmіrno Tovsta ball schіlnoї fіbroznoї tkanini on mіstsі parієtalnoї i vіstseralnoї pleurisy, generally produces scho to digit zmenshennya obsyagu gemіtoraksa, zvuzhennya mіzhrebernih promіzhkіv, zmіschennya seredostіnnya in bіk urazhennya. The price is less significant for the decrease in the indicators of the function of the external dichotomy, as a result, as a deterioration in ventilation, as well as in the case of an increased reduction of the lung blood flow. Such a deterioration in the function of the out-of-the-box environment is promoted by extensive thoracoplastic operations with the help of a tamponadi drive soft fabrics chest wall for resection of ribs. At the same time, a gross cosmetic defect can be found in case of an unstable period of operation, it is superseded by a sharp deformation of the ridge at the distance of the term.

In such a rank, from the luckiest positions, the most important result of the elimination of pleural effusion and the elimination of pleural emptying as a result of the formation of intermittent pleurodesis (fibrothorax), does not interfere with the callus. The unpleasant result of the illness є the formation of chronic pleurisy, the oskilka ї ї ііkvіdatsiya unpleasant without a highly traumatic, only difficult and difficult operation, the results of which are naturally good.

The delivery of the vipiskey to the stationary for the patients is carried out on the offensive:

Correction to the regime of practice and the way of life;
vidmova vid kurinnya;
povnotsinne harchuvannya;
prevention of respiratory problems;
physical culture, including dichny gymnastics;
bronchodilators, mucolytics;
sanatorium and health resort lykuvannya.

Medical and social examination... The term of a team-hour non-standard can take 2-4 months, and in the case of an operative treatment - 4-6 months. The criterion for the whiskey of a sick person from the hospital is the achievement of clinical training, and in the case of the chronization of the process - the achievement of clinical and radiological remission. To the patient of contraindication of the sight of pratsi, tied with a robot in a chicken and gas-polluted environment, with being overwhelmed in uncomfortable meteorological minds (a change in temperature, a change in the sense of the word), we are significant in other words. With the available types and minds of pratsі paciєnti pracezdatnі. In the necessary conditions for the whiskey of ailments, I will switch to "easy work" through the clinical expert committee, or it is necessary to change the nature of the robot.

Ailments from suppurative diseases of legends and pleurisy can be recognized as invalids from a glance at the changes in clinical manifestations (intoxications) and sound of cola of available professions. With chronic pleurisy, the II group of invalidity arises. On іnvalіdnіst translate paciєnti, yakim bulo vikonano operatively involved in the legends. For the operation of lobectomy, it may be established whether a group of invalidity is at the stage of a legacy deficiency (for in some situations, it is possible to practice through a clinical-expert) com- The operation of pleurectomy and decortication of ailments is transferred to the III or II group of invalidity in a line for 1 ric from the more advanced periodical look (in the presence of the degree of legacy inadequacy). During the operation of pneumonectomy, the II and the first group of invalidity are established.

Ukladach and editor - Lishenko V.V., Associate Professor of the Department of Surgery innovative technologies VTsERM im. A.M. Nikiforova of the Ministry of Taxes and Legends of Russia, head of the department of medical surgery of the clinic of the hospital surgery of the Russian Medical Academy in the period 1991-1998.

Zolotarov D.V., Candidate of Medical Sciences, Head of Department of Medical Thoracic Surgery, Moscow City Clinical Hospital No. 23 іm. Medsanthrud "DZ r Moskvy; Senior Scientist of NDV" Khirurgicheskaya Infecciya "NDC GBOU VPO First MGMU Im. I. M. Sechenov Ministry of Health of Russia

Skryabin S.A., Head of Thoracic Surgery, Murmansk Oblast Clinical Clinic. P.G. Balandina.

Popov V.I., Doctor of Medical Sciences, head of the Department of Medical Science in the period 1998-2005.

Kochetkov A.V., Doctor of Medical Sciences, Professor, Head Surgeon at VTsERM IM. A.M. Nikiforova, a spokesman for the genius legendary classics im. P.A. Kupriyanova Vyskovo-medical academy in the period 1982-1986 rr.

Ugorov V.I., Ph.D.

Deynega I.V., Zaitsev D.A., Velikorechin A.S.

Consultant: Professor G.S. Chepcheruk Professor A.L. Akopov

ICD code 10

J86.0 pothorax with fistula

J86.9 pothorax without fistula

value

Empima of pleurisy is gnine (rotten) burning, which develops in pleural emptyings from lesions to the pathological process of parietal and visceral pleurisy.

Ethiology and pathogenesis

Development of gnarly abnormally rotten inflamed pleural effluvia in large swellings in the anterior (except for inflamed pleural effusions from the lung, middle and t.P.) The price is associated with the increased penetration of the blood-bearing and lymphatic capillaries of the cortical balls of the lungs, which are involved in the perifocal ignition reaction in case of advanced pathological processes, the persistence for everything in the lung parenchymal lesions, as well as in chest injuries. Accumulated exudate in the pleural effusion of the mesothelial ball, blockade of the wet surfaces of the pleurisy by inserting fibrin on them.

It is not a common factor for the development of pleurisy the manifestation of noninfectious pleurisy of the genesis - infectious-allergic (rheumatic, rheumatoid), pleuritis in case of colagenosis (systemic cervicitis) Ridin in the pleural emptying can accumulate in case of lack of blood circulation, chilothorax. The exudative reaction is spontaneous in the presence of blood in the pleural empty space (T.N.

The penetration of microorganisms into the pleural exudate - "infusion of pleurisy" - is carried out in small ways. Lymphogenous inflammation of the pleural emptying is associated with the retrograde struma of the tissue type during ignition processes in the lung parenchyma (pneumonia, bronchitis, gnarial bronchitis, rooted abscesses of the lungs), abscesses in the abscesses of the lungs), abscess

Children of the past see a hematogenous pathway of penetration of infection in the pleural empty space (sepsis, septic embolism of small cola blood circulation), protein in cich vipads cannot be reliably

viklyuchiti and parapneumonic nature of pleurisy and pleurisy in the case of lymphogenous inflammation of the pleural space. Directly the information of the pleural emptying with the development of the pleurisy rate, if microorganisms penetrate into the pleural emptying from the midst of the queens, foreign bodies, wounding projectiles, it is typical for the chest organs At the same time, the exudative reaction was overwhelmed by the injury of the pleurisy, and the tears, the blood swelled, and the infectious process itself. In the case of the cich in the tempo of the pleurisy, the author is called primordial.

To speak about the bezposredny way of infliction of pleural emptying when there are subcortical growths in it, subcortical growth of legacy parenchyma. Getting into the pleural emptying of a great number instead of the gnarly wiklikє burhlivy exudative reaction, and the resorption of microbial toxins in the intact pleura in the early stages of the development of the process of the toxic-inflammatory process. The same mechanism for the development of an infectious process in the pleural emptying is promoted in case of lung gangrene, if a rotten breakdown is caused by a great number of lesions of the parenchyma at once from the visceral pleura. The post-microbial infection and the broadening of the process (the acquisition of all types of pleurisy, including parietal ones) will add to the particular severity of interrupting the rate of pleurisy with such a mechanism of pleurisy.

The given development and the nature of the infectious process in the pleural emptying of the penetration in its microorganisms lie in the bagatokh factors, however, the most significant is the microorganism

і zahalny immunity, a kind of zebra.

V etiologic structures of pleurisy rates, according to the data of the last dyslidzhen, re-ferment staphylococcus, streptococcus, synginia palichka, proteus. Most of the third species of microorganisms are found in the association with numerous species of non-clostridial anaerobic microflora (bacteroid, fusobacteria, peptostreptococcus). V cob stages The development of discomfort is promoted, as a rule, the improvement of the exudative reaction of the pleurisy, as a rule, is due to the attribution of tissue structures to the block of tissue structures in the glib balls of the pleura as a result of burning, the accumulation of the accumulation of pleural defects. A high vist for fibrinogen in the pleural exudate to form significant fibrinous nasharuvans on the pleural empty spaces, setting up thick detritus, especially in the lower cases. When the reactivity of the organisms swings into the pleural empty space, neutrophilic leukocytes, macrophages begin to flicker, the processes of phagocytosis grow, and the exudate quickly transforms into gnіyny. At the end of an hour, the exudative phase becomes proliferative: granulation is formed on the pleural sheets, which is formed by adhesion (mooring). The appearance of a great number

pleural mooring, overhanging the proliferative reaction over the exudative accumulation more friendly perebіg empієmi pleurisy. Tse are tied to the interconnection of the pathological process. With a significant decrease in the reactivity of the body, the reparative processes are caused by an expansion of a rotten or rotten process, the rate of swelling of a total character, which, when there is a daily help, to produce a sickly death.

Nerіdko rozvitok empієmi pleura vіdbuvaєtsya on tlі pomіrnogo znizhennya pokaznikіv mіstsevogo i zagalnogo іmunіtetu scho zumovlyuє torpіdnіst perebіgu Process: vіdznachaєtsya digit obsyag fіbrinoznih vіdkladen on pleural sheets, adhesions mіzh them puhkі, granulyatsії mlyavі, zagalmovano osvіtu zrіloї spoluchnoї tkanini. Such special features of the fiery reaction begin to become strong until the chronic interruption of the process, if new fibrinous masses emerge in our organization of fiery heat.

However, the most frequent reason for the transition of a hostile process in chronic and post-mortem disease of pleural emptying in the presence of evidence of infection in the lung (abscess, gangrene), with type of fistulas - bronchopleural, pleuropulmonary.

A slid of adhesion, which is not resorbed from the pleural empty space, is not resorbed. The natural process will inevitably end with a breach of the gnar in the bronchial tree, or when the breast tissue is melted (empyema necessitatis). Ridko, with an insignificant general exudate, it is possible to intervene with strained adhesions and trivial (rock) effects. Such results, as a rule, should not be brought to sleep, fragments of the natural sanitation of pleural emptying in these cases is unhealthy, because of a certain period of good fortune, there is a relapse of hereditary burning.

Uninvolved on the over-insured particularity, overcoming the ignition process in the pleural emptying and outward-facing specific manifestations of the disease. Before them, the deteriorated function of the outgoing dichotomy is brought to the fore, linked to the vicarious from the decision of the legacy parenchyma pressed by the exudate on the side of the battle, and in the case of the change in the middle and on the other side. Often the reason for the unsafe for the life of mental disorders is the total collapse of the legacy when leaking in the pleural emptying of the legenous gnarium due to the formation of the valve mechanism (tension of pneumothorax). At the beginning of the term, the turn of the sickness is due to two factors: the step of the collapse of the legion (the amount of empty empty space) and the camp of the legacy parenchyma;

legeny tissue (pleurogenic cirrhosis of legeni). The most characteristic retinal, systemic manifestation of a glandular-ignition process in pleural emptying and intoxication, is associated with the resorption of microbial toxins, is provided in case of a high degree of acute inflammation to an acute polyorganic deficiency in

In such a rank, key Lankas, the pathogenesis of pleurisy є:

1. The appearance of birth in the pleural emptying as a result of the development of the primary pathological process (non-bacterial pleurisy, hydrothorax) or injuries.

2. Inflammation of pleural emptying and development of gnarial inflammation, especially when it breaks down, starts with resistance to organisms, virulent microorganisms.

1. Behind the change from the most recent midst

pleurisy

	tucked away			vidkrit
				see (reported by an external
	NOT reported reported to external			external environment))
	zovnishnim middle)			external environment))

From pleurodermal fistula - from bronchopleural fistula

From the bronchopleurodermal fistula - from the pleuroorganic fistula - from the bronchopleuroorganic fistula

It is easier to eat (discussion of nutrition)

2. For volume

pleurisy

total	subtotal	provided
When Rg is extended	start only	when moored
Legeneva fabric on not	start only	when moored
Legeneva fabric on not	top of the legend	eksudatu
start	top of the legend	eksudatu
start

for localization

by pathogenesis

- parapneumonic;

A lot of destructively destructive legends;

- post-traumatic;

- pislyaoperatsіyna.

3. Most of the authors see the triviality of the pathological process gostru, pidgostru and chronicle pleurisy rate. However, such a rise in pleurisy is only due to triviality, and in some cases, and morphological signs chronic heat(Formation of healthy fabrics) to be smart in nature. In some children with circulating reparative health problems, there is a rapid growth of fibrinosis on the pleura, and in some of them there are processes of suppression, so that "fibrinolytic therapy" is adequate. Thus, in the capacity of the classical signs of a state of health or of a chronic appearance of pleurisy (with the presence of a lung), it follows that the morphological changes are not in the pleura, but in the legacy of parenchymal disease (the result of pleural effusion). enticing. I am familiar with the development of chronic

pleural effusion due to pneumonectomy followed by the presence of pathological processes - bronchial fistulas, osteomyelitis of the ribs and sternum, nasal chondritis, side effects - to add to the unpleasantness of the disease Thus, for the treatment of chronic pleurisy, it is necessary to be more promptly promptly involved, with the treatment of pleurisy, the treatment can be achieved without radical operations (pleurectomy with decortication, in the case of additional surgery).

At the same hour, the test in the quality of the approved criterion is the triviality of the disease (up to 1 month - gostra, up to 3 months - the gostra, after 3 months - chronic) when the formulation of the average diagnosis is necessary for the correct dosage, lіkuvalnoї programs.

With the help of the control of the surroundings, up to the chronic rate of the pleurisy, it is possible to carry out a pathological process, which I will call it “easy to buy”. This term means a camp that develops when there is a wound (surgery) of the breasts and lungs, if to a great defect in the breast tissue, the Lehene's tissue is "soldered" to the absence of other bronchial fistulas.

Clinical manifestation and diagnostics

Clinical manifestations of pleural effusions to complete the development of the disease, which is accompanied by the development of pathological changes in the pleural empty space, by the peculiarities of the interruption of the infectious process in the specific skin disease. The stench is overwhelmed by the breadth and localization. Protein in the most important cases, symptoms are clearly manifested

- foreign anti-toxicity

- rozladi dikhannya

- show a different step of the turn of the "miscev".

Unimportant to the spirituality of the main clinical manifestations of pleurisy, it is necessary for the nobility of particularity, as may be deyaky okremi vidi tsiogo ill.

Pyopneumothorax is a type of gastrointestinal pleural effusion (in the form of bronchopleural appearances, which is opposed to the lasting purulent destructive process in the lung); Tsey term viv in the living of S. І. Spasokukotskiy (1935 r) for the important, “... I’ll become hospitable, for an hour, and I’ll also be the closest to drink pus and go to the pleural empty space from the abscess of the lung ...”, if “... then less clearly turns the stun to shock

for, in every case, the death of a sick person is less significant. " Assigned changes in case of pneumothorax tying at the time of yogo

vinnennya with the development of pleuropulmonary shock, vyklikannye razdratuvannya pus and witnesses of the great receptor field of pleurisy, septic shock as a result of the resorption of the pleura of the great number of microbial toxins. However, the greatest concern for the life of a sick person is the failure of the valve mechanism, which leads to the development of a stressed pneumothorax, which is characterized by a significant increase in the grip in the pleural empty space, the collapse of the lungs, the bloody systemic wrinkles In the classic picture, they show heart-vascular deficiencies (depression of the arterial vise, tachycardia) and mental deficiencies (badness, venom, cyanosis). The release of extravagant assistance ("unbinding" punishment and drainage of the pleural emptying) can be fatal for a sick person. To that, the implantation of the term "pyopneumothorax" in the capacity of an early diagnosis is competent, since the goiters are called to the intensive care for the ailment, the prompt verification of the necessary diagnosis, and all medical personnel - to the necessary

Osoblivіstyu klіnіchnih proyavіv posttraumatic in addition chislі pіslyaoperatsіynih empієm pleurisy, Je rozvitok іnfektsіynogo Process for tlі vazhkih Change log, viklikanih trauma (operatsієyu): torn down tsіlіsnostі grudnoї klіtki i pov'yazanimi of her rozladami zovnіshnogo dihannya, lung injury, scho prizvodyat to viniknennya bronchopleural Notification , blood loss, the manifestation of blood loss and exudate in the pleural empty space. At a number of early manifestations of the appearance of pleurisy (increased temperature of the heart, deterioration of the disorder, intoxication), masquerading as such frequent accelerated injuries of the breasts, such as pneumonia, atelectasis, hemothorax;

In klіnіchnіy kartinі hronіchnoї empієmi pleura prevalyuyut Find our hronіchnoї gnіynoї іntoksikatsії, vіdznachayutsya perіodichnі zagostrennya gnіynogo Process in plevralnіy porozhninі scho protіkayut on tlі patologіchnih for Change, scho pіdtrimuyut hronіchny gnіyne broken-winded: bronhіalnih svischіv, osteomієlіtu ribs, sternum, gnіynogo hondritіv. An uncommon attribute of chronic pleural tempo is the stike of the overflowing pleural empty space with these walls, which is stored from the strained layers of the inner tissue. Sclerotic processes develop in adjoining patients with legacy parenchymal processes, as well as the development of a chronic process in the lung - chronic pneumonia, chronic bronchitis, bronchiectasis, which may have a typical clinical picture.

At the current stage of diagnostics, verification of the diagnosis of "pleurisy rate"

storing exchange methods until the end of the day. Naybilsh informative method of X-ray dosage with EP є Computer tomography The wide range of possibilities for removing 3D images, allowing you to correct the data for the diagnosis formulation for all the classification categories right before the hour. More forgiven by the method of X-ray dosage є

polypositional fluoroscopy... Vaughn allows you to accurately establish the localization of the pathological process, by the number of steps in the interconnection of the exudate (vilne volodinnya or embedment), and also to complete precisely the significance of the matter.

For an accurate measurement of emptying empires, її configuring, I’ll become stinoks (Tovschina, the manifestation of fibrinous nasruvans), as well as verification and clarification of the localization of bronchopleural disease polypositional pleurography, including lateropose... For carrying out in the pleural empty space through the drainage (before - punctual), 20-40 ml of watery contrasting speech is injected.

Velmi informative dosage є ultrasound pleural emptying.

The whole method allows for a more detailed assessment of the nature of the pleural emptying (the number and the nature of fibrinous nasharuvans, the ball of birth without the middle before the cob, etc.).

With the presence of pleurodermal fistula, valuable information can be eliminated with fistulography, with radiological abnormal CT scan.

Endoscopic methods ( bronchoscopy, thoracoscopy), as well as ultrasound scan allow you to make more detailed statements about the nature of morphological changes in the pleural sheets, in the pleural empty spaces and in the legacy tissues.

Bronchoscopia, vikonuvana in ailments with pleural effusion, ma on methi vyklyuchiti central cancer of the leg, infrequent viklikє pleural carcinomatosis (cancerous pleurisy), which transforms into pleurisy in case of infarction of exudate; to carry out the sanation of the tracheobronchial tree with the manifestation of a destructive process in the lesions, until the bronchial fluid is progressed (seeding, etc.) with the establishment of a microbiological agent and the preparation of a rational antibacterial therapy. The information can be cleared by combining bronchoscopy with the introduction into the pleural empty space for the drainage of the farbuval rosette of the vital barvnik (retrograde chromobronchoscopia). Therefore, as a barvnik enters into the education of subsegmental and segmental bronchi, it is possible precisely not only for localization, but for the broadening of bronchopleural conditions. In some cases, information about the localization of a bronchopleural fistula can be eliminated with selective bronchography by means of the introduction of a waterborne contrast speech through the fibrobronchoscope canal, inserted into the zonal bronchus,

Leaves with further accumulations of large masses in the pleural emptying. Disease vimagak negativny i complex treatment, So yak, in a nasty way, there is a lot of growth of the mass.

A short information about getting sick

Empima of pleurisy (ICD-10 introduced this pathology code J86) is an important part of the disease, as it is supervised to get burned by the leaves of the pleurisy. At the same time, in the anatomical empty spaces (pleural empty spaces in this particular type), they can repair the accumulated mass.

As the statistics show, the number of people stuck with similar ailments three times more often, not the representatives of the beautiful stati. In a large number of patients with accelerated pathologies.

Causes the development of ailments

The causes of pleurisy may be small. As soon as it’s about the primary form of the disease, then the triggering mechanisms in this type of activity are the activity of pathogenic microorganisms, penetrating into the empty blood, or maybe, as well as lowering the immune system. Primary empima (in medical ailments, also figurine under the name "gnіyny pleurisy") develops when:

damage to the integrity of the breast tissue due to aphids or injuries;
earlier transferred surgical entanglements, as the stench caused bronchial fistulas to be confirmed;
thoracoabdominal diseases of the breast cancer.

Secondary genital pleurisy develops on the other pathologies. List of їх to complete the values:

gn_ain processes in any system of organs;
fired fabrics of legends;
svitaabstses in the fabrics of the legends;
oncological incapacitation of the mental system;
spontaneous pneumothorax (damage to the integrity of the pleural empty space);
inflamed appendix;
wiry ailment slink i intestinal tract;
gangrene legen;
cholecystitis;
peritonitis;
approval of gn_ynik_v in the oven;
sepsis;
osteomyelitis;
having cut the stravohode;
inflamed pericardium;
ignition processes in the bottom hole;
Infectious diseases of the organs of the respiratory system;
tuberculosis.

Of course, it means that an ailment can be triggered by activation of some pathogenic microorganisms, sprouts, pneumococci, streptococci, staphylococci, tuberculosis bacillus, ailous fungi and anaerobic bacteria. The pupils can eat in the tissue and the dyshnoy system at the same time with the flow of blood and lymph from their organs.

Empiєma pleurisy: classification

On the current day, there are no ill schemes that allow the classification of pathology, and it is also necessary to accept the most advanced officials.

For example, in the absence of a particularity and triviality, I see the state of the art and the chronic rate of pleurisy. Symptoms of other forms may be different. For example, in case of a state-of-the-art ignition process, signs of intoxication should be considered the first plan, while the disease is less than a month. As far as the chronic form of the ailment is concerned, the symptoms are more masked, and the patient is more disturbed for a trivial hour (more than 3 months).

Due to the nature of the expiration of the emptiness, it can be gniynoy, specific, rotten and wicked. If it is closed (it is possible to take revenge in the pleural emptying and not to be named) and in the form of discomfort (to prevent the formation of fistulas in the pleurora and lungs, bronchi, skin, circulatory system)

Before respecting, take і obsyag perfected with pus:

small empієma - obsyag gnіynyh masses do not perevitє 250 ml;
middle, when yak_y obsyag eksudatu transport 500-1000 ml;
great pace - to promote the purchase of great quantities of pus (more than 1 liter).

Falsely from the growth of the pathological process can be either one- or two-sided. Zrozumіlo, all tsі characteristics are important for the folding of an effective scheme of treatment.

Stages of development of ailments

On the current day, three stages of development of this pathology are seen.

The first phase is serous. At pleural empty beginnings, serous vipit accumulates. Even though at the whole stage of the patients it was not given any additional help, then in the serous age, actively reproduction of pyogenic flora should be started.
Another stage is fibrous-serous. The exudate in the pleural empty space becomes cloudy, which is associated with the activity of pathogenic bacteria. On the surface of parietal and visceral leaves, fibrinous deposits form. Adhesions are formed stepwise between sheets. Thick gn_y accumulate in the leaves.
The third stage is fibrous. At a number of stages, it is necessary to promote the establishment of nodular adhesions, as it is easier to shackle. Oskіlki legeneva fabrics are not functioning normally, then they will also be susceptible to fibrous processes.

symptoms of pathology

Gostra form of empієmi legenіv supravodzhutsya to fill up with characteristic symptoms.

The temperature of the patient's body is moving.
Presence of symptoms of intoxication, frost, chills, aches and pains in the meat, drowsiness, weakness, fatigue.
Characteristic familiar emmpієmi є cough. The wine is dry, ale step by step becomes productive. When coughing, there is sputum of a greenish-yellow, gray or life-like appearance. I often see an unacceptable smell in the edge.
Before a bunch of symptoms come up and a slowdown - a chance to lose an hour of physical activity, but instead of a patient's turbulence in the country of calm.
In the world of progressing pathology, there are pains in the sternum, which will respond to vidiha and vidiha.
The change of the robotic dysfunctional system and is recognized as the function of the heart, wobbling and disrupting its rhythm.
Patients tend to skip for weakness, shortness of breath, decrease in performance, perceived growth rate, increased appetite.
The destruction of the robotic system is superfluous by the hour and symptoms. For example, the skin on the lips and fingertips of the patient's swelling cyanotic appearance.

How to check statistics, approximately in 15% of cases the process goes to chronic form... At the same time, the picture of the viglyad is in the best way. Symptoms of intoxication in the daytime, as well as temperature changes. The turbulent patient's cough is post-mortem. Patients can also be prone to recurring headaches. With the appearance of the disease, the development of deformities of the breast tissue develops, as well as scoliosis, which is associated with some compensatory mechanisms.

may you expedite

As a result of statistics, it is correct to select the add-on help from the pleurisy rate. Folding, prote, mozhliv_. List of їх offensives:

degenerative changes of nirok;
serioznі damage of the myocardium, nirok і deyakіkh інshih organs;
formation of blood clots, blockage of the sudin;
polyorganna lack;
education of bronchopleural fistulas;
development of amіloidose;
thromboembolism of the legacy artery, is associated with thrombosis (in the form of extreme surgical intervention, as in the opposite direction of the temporality of the lethal result).

Yak can be patted, the inheritance of ailments are not safe. Itself, in any case, it is not possible to prevent the symptoms of a disease and are seen as a result of the help of a qualified failure.

diagnostics come in

Diagnostics of the pleurisy rate in the edge is important. Before the lіkar, it’s not only necessary to confirm the presence of pyothorax, but also because of the nature of the pathological process, the steps of its expansion, and the cause of the blame.

For the ear, an anamnesis is carried out, and the patient's medical tributes are given. When you look around the chest wall, you can notice those steps of deformity, vibuhne or the smoothness of the mid-ribbed spaces. As soon as the patient is talking about chronic pleurisy, then the patient has scoliosis. It is even more characteristic є the drooping of the shoulder and the vipinny of the scapula from the side of the lesion.
Auscultation should be performed in a binding manner.
Nadal the patient will be sent to the child's life. Observational є laboratory analyzes of blood and slaughter, for which it is possible to see the ignition process. Conducted microscopic dosage of sputum and aspirated birth.
Zrazki eksudat vikoristovuyt for bacterial seeding. Such a procedure allows the visibility of a kind and a kind of a child, converting the steps of his sensitivity to quiet licks.
Informative - fluoroscopy and radiography of the legends. On the signs of the battle of the darkening.
Pleurophistulography is a procedure that will help you to develop fistulas (like a stench є).
Pleural puncture and ultrasonography of the empty pleural space are also performed.
Inodi of the patient is additionally directed to magnetic resonance і / abo computer tomography... Such advances will help the reader to assess the structure and function of the legends, to determine the purchase of the exudate and to assess the report, to diagnose the appearance of the quiet ones.

On the basis of the given drugs, it is necessary to develop an effective drug regimen.

therapeutic treatment

Lіkuvannya empієmi pleurisy in Pershu Chergu transferring vividness of the mass - it can be done as soon as the punctuation, so for the additional support of the rosette of the breast clerk (until the whole method is thrown into the extreme).

As soon as the knowledge of this exudate in this world is associated with the activity of pathogenic microorganisms, then it is necessary to inject antibiotics of a wide range of diets in the form of tablets into the therapy regimen. Effectively, preparations from the group of aminoglycosides, cephalosporins, fluorochinolones are used. Besides, it is possible to inject some antibacterials into the pleural empty space without the need to inject them to achieve the maximum result.

Some patients recognize the transfusion of blood preparations, for example, special hydrolyzates, albumin, purified blood plasma. Additionally, glucose and electrolyte solutions are introduced, which additionally help the organism to be introduced to the robot.

Obov'yazkovyu є immunomodulatory therapy, as well as the reception of vitamins complexes - at the same time additional help to empower the robot of the immune system, which, in its own way, to the quick renewal of the organism. Conducted і For example, with a bend of feverish vikoristovuyutsya heat-lowering and non-steroidal anti-burners.

In order for the symptoms to become less severe, patients should be advised of physiotherapy. Special dichal gymnastics additional assistance to the development of interrelation, normalization to the robot of legends, to the development of the organism in sourness. We will be cinnamon and therapeutic massage, which also helps to cleanse the legends of phlegm, to improve self-respect for the body. Dodatkovo sessions educational gymnastics... Incorrect results and ultrasound therapy. Before an hour of rehabilitation, I recommend to the patients to go through the new sanatorium and health resort.

If you need surgery?

It is a pity that some of them fit in because of the illnesses they additionally helped to deprive them of surgery. Empima of pleurisy, which is characterized by chronic interruption and purchases of a great amount of pus, in the form of operational involvement. Other methods of therapy allow to relieve symptoms of intoxication, elimination of fistula and emptying, discharging the damage more easily, vividing the symptoms of pleural emptying.

One day to see thoracostomy with more visible drains. Inodі lіkar pіshennya about vіdalennya doyаkіkі fіlyаnki pleurisy wіth a fоr decoration оf thе legacy. If fistulas are between pleural tissues, bronchial tubes, legends and shkiri, then surgery is curved. In addition, since the pathological process is not easy to expand, then a decision can be made about the part of the body or the resection of the affected organ.

Help folk medicine

Therapy in case of a similar illness is usually guilty but complex. First and foremost allowed roslinnykh zasob_v.

It is effective to get into an extravagant bow. Gotuvati Liki is simple. Clean the cybulin of the middle size from the lush pinnacle, rinse and remove. It is also necessary to find a drink and make a difference with natural honey (in small quantities). Likki recommend to accept two for dob on the tablespoons. To get involved, it’s wonderful to cope with a cough, lingering sputum.
At home minds, you can prepare an effective mucolytic zbir. It is necessary to change the amount of rіvnі kіlkostі of the root of the Oman, the herb of the mother-and-machuha, the mint, a portion of the lip and the root of the licorice. It is necessary to pour a bottle of sprinkle over 20 g of strawberry sum, if it is necessary to insist on it. We would like to send the cooling process to three portions of the day. A skin day is required gotuvati svіzhe lіki.
It is effective to use polovian horsetail. 20 g of dry grass of a roselin (detailed) need to be poured over 0.5 l of sprinkle. It is necessary to write and surrender for two years on a warm meeting, because of this process. It is recommended to take 100 ml of chotiri razi for doba for 10-12 days.
є lykarskiy zbir, I will lie down the process of dichannya and additional help to cope with the backside. It is necessary to pick up immortelle grass, dried leaves of calendula with leaves of currants, tansy and bird cherry in small quantities. Pour a tablespoon of sumіshі with a bottle of sprinkling and insist. Take two or three tablespoons for doba three times.
Є є problems with the robotic dichotomous system, then it is necessary to use natural honey and fresh radish juice in small quantities. Herbalists recommend taking drinks every day.

Zrozumіlo, vicoristovuvati homework can be deprived of the permission of fahіvtsya.

It is a pity that the specific prophylactic tasks are not insane. Protect the rules to please follow the rules:

all fired up(Especially in this case, if the stench is supervised by a gn_yny process) vimagayut free therapy;
it is important to change the immune system, so as to reduce the risk of development of those who are ill (it is necessary to correctly magick, to pump up the body, to take in vitamins, to spend an hour on a new occasion);
it is not a common practice for prophylactic scrutiny - the earlier the disease will be revealed, the less the development of the quiet slower.

Of course, it means that in a large number of cases, as well as getting sick, it is good to go to therapy. Empієma plevri not darma vvazhaєtsya not safe pathology- іgnoruvati її is not varto. According to statistics, approximately 20% of patients develop as soon as possible. The lethality in case of a likelihood of ailment is between 5 and 22%.

nasal pleurisy

RCHRH (Republican Center for Development of Health Protection of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2015

Pyothorax without fistula (J86.9), gn_y with fistula (J86.0)

Pulmonology, Thoracic surgery, Surgery

General information

Short description

expert joy
RSE on REM "Republican Center
protect your health "
Ministry of Health Protection
and social development
Republic of Kazakhstan
from "10" breast 2015 rock
Protocol No. 19

Name of the protocol: Empiєma pleurisy in grown-ups

Empієma pleurisy (gnіyny pleurisy)- Proposition of a diffuse inflammation of the visceral abnormally parietal leaves of the pleurisy, which contradicts the accumulation of gross exudate in the pleural (physiological, anatomical) empty and superimmune diseases

Chronic pleurisy rate- a gnarly-destructive process in excessive pleural emptying with coarse and stiff morphological changes, characterized by trivial interruptions with periodic sharpening.

Protocol code:

MKX 10 code:
J86.0 - gn_y z f_stuli
J86.9 - without fistula

Fast, as vikoristovyu in the protocol:
ALT - alanine aminotransferase
AST - aspartate aminotransferase
АЧТЧ - assets partial thromboplastin hour
VIL - virus to human immunodeficiency
K - kaliy
Na - sodium
Ca - calcium
DN - insane lack
ІТШ - infectious toxic shock
IFA - enzyme immunoassay
CT - Computer tomography
INR - internationally normalized relations
MRI - Magnetic resonance tomography
UAC - zagalny blood analysis
OAM - zagalny analysis of the sech
OEP - gostra empієma plevri
TT - thoracotomy
TS - thoracoscopy
SHOE the rate of accumulation of erythrocytes
SPL - ultrasound dosage
FBS - fibrobronchoscopy
FEGDS - fibroesophagogastroduodenoscopy
Hep - chronic pleurisy
EHC - electrocardiography
EP - pleurisy
EFFGS - endoscopic esophagogastroscopy
EhoKG - echocardiography

Date of release to the protocol: 2015 rіk.

Coristas to the protocol: thoracic surgeons, medical surgeons, therapists, infectious diseases, pulmonologists, anesthesiologists-resuscitators, doctors and paramedics medical aid, Likars of foreign practice.

рівень I	Prove that, in the course of taking into account, in the course of taking into account one proper rank of the broken-down vipadkovy controllable to the end of the meta-analysis
рівень II	Prove that in the course of taking into account one kindly broken-down clinical vip test without proper randomisation, as an analytical cohort, or as a result of the type of video ad-control (which is important from one center), or as an example of the result of some kind of non-control drama
рівень III	Prove that the thought of reputable preachers on the basis of clinical advice
class A	Recommendations, as bully grabbed for the weather took 75% of the total number of experts in the multisector group of experts
class B	Recommendations, such as bully kilka spirni and did not make the year
Class	Recommendations, as they winked about the real differences among the members of the group

Classification

1. CLINICAL CLASSIFICATION:

There is a clump of the classification of pleurisy.

For ethological acquaintance	For pathogenetic knowledge	Behind the character of the battle of the legendary fabric	Due to the nature of the evacuation of the emptying empiєmi with the zovnіshnіm middle і bronchial tree	For the localization of the empty lights you see	for the broadening
nonspecific	para- and metapneumonic	pace without destruction of legacy fabric (non-folding)	close empiєmi	apikalny	total
specific	pislyaoperatsіynі	the pace of destruction of the legacy fabric (accelerated)	pacemaker with bronchopleural, bronchopleurothoracic and pleurothoracic fistula	interlobe	widening (diffusion)
zmіshanі	traumatic			paramedial;	enclosed
	metastatic			pristinkov
	contact * (transition)			basal and їх combinations
	sympathetic ** (sympathetic, bichni) pleurisy

* To contact the following:
- empієmi as soon as I cut through the midges;
** Up to cute:
- pacemaker with sub-phrenic abscesses
When there is an increase in the process, one layer of pleural emptying is drawn into the process, with an extended (diffusion) rate in the process, two or more layers of a pleural empty

Behind the step of squeezing the lung, take three steps to the collapse of the legend:

per key type develop :

GOSTRI

підгострі

septic

chronic emotions

The interconnection of these forms is complementary, but even more important through the visibility of the readable signs of the transition of the hostile emotions into the chronic stage.
Vidi empієmi pleurisy:
· Gostrі (triviality up to 8 years old);
Chronic (the triviality of the disease is more than 8 years).
Statements and chronic pleurisy rates are subdivided into groups:
Behind the character of the exudatu:
- gnіainі;
- rotten;
- anaerobic.
Behind the character of microflori:
- specific (tuberculous, actinomicotic, syphilistic, etc.);
- nonspecific (staphylococcus, streptococcus, pneumococcus, anaerobic, etc.);
- due to the change in flora.
For walks:
- pervinnі;
- second.
Behind the character of the appearance of the name of the middle:
- do not appear because of the middle-class (vlasneempієmi);
- from the development of the midst (pneumothorax).
By the width of the process:
- great empire (total, subtotal, small);
- enclosed (embossed) empiєmi:
- pristinkovi (paracostal)
- basal (between the diaphragm and the surface of the lung)
- interlobar or interlobe (in interlobar boron)
- apikalny or upper (above the upper lung)
- mediastinal (lay down to the middle)
For a number of empty:
- single chamber;
- large chambers (large purchases in pleural empty spaces with adhesions).
For the obvious quickening:
- not accelerated;
- accelerated;
- phlegmon of the chest wall;
- Aspirating pneumonia of protylezhnoy legenia;
- gn_yny pericarditis;
- myocarditis;
- sepsis;
- Gostry osteomyelitis of the ribs;
- erosive bleeding from intercostal artery and upper chest wall;
- hypoxic slopes of the slunk with bleeding;
- thromboembolism of hylok legenevoy artery;
- hypoproteinemia with anasarca;
- contralateral spontaneous pneumothorax;
- hemoptysis or bleeding Legeneva.
For a key interruption:
- to counter the turning intoxication in the form of a boisterous fiery ignite of the emptying by the momentum abo / that firing of the igniting process in the legends;
- to pass through the room with intoxication;
- "erased" with a classic picture and a compensated camp of a sick man.

key picture

Symptomy, stretching

Diagnostic criteria:

Skargi and anamnesis: as the rule of the EP will be found on cleverly show of that primary illness (pneumonia, abscess legeni, pleurisy), it became easier.

skargi:
Strong, prickly bile under the ribs (localization of pain to lie down due to the anatomical features of the development of pathological (gnarial) exudate and the formation of adhesions (fibrous grains) to the process (supraphrenic, interlobar medullary, etc.)
· Skhudnennya;
· Waste appetite;
· Weakness;
· Frequent dry, obtrusive, painful cough, in some cases (with the presence of bronchopleural fistula), it means seeing phlegm or pus;
· Relapsing fever;
· Symptoms of acute intoxication: dry cough, temperature 39-40 0, tachycardia;
· Frequent, non-top (superficial) dikhannya;
· Zadishka;
· Gnіynі vidіlennya from the fistula of the chest wall (yakshо takiy є);
· Bloating at trivial and build-up intoxication.

anamnesis:
In the anamnesis of the ailments, there was a history of exudative pleurisy for the transfer of gostria. In some cases, pleurisy buv "vilikuvaniyu" conservatively, in some of them one accepted operation was carried out, when an unprotected fistula of the chest wall was lost, but a small amount of pus was seen.
If you get sick on the EP, you will have to fix severe prickly pains in that half of the breast cavity, you will be able to do it if you have a strong or cough (level of evidence - III, strength of recommendation - A).

Physical details:
· Western breast cancer, ringing of the mid-ribbed spaces, kifoscoliasis, intercourse of the dormant excursion of the half of the breasts;
· Percussion viznachate dullness, dichny noises are very weakened or not carried out;
· Sweating of nigty phalanges of the fingers (with a trivial, hopeful process);
· Improvement of liver and spleen;
· Shkіra and pіdshkіrni balls of soft fabrics can be hyperemic, because of the bump and the painfulness;
· Vimushene position through bіl and zadishki;
With a trivial and running process, symptoms of cerebral intoxication can be prevented: psychotic, Headaches, sleepiness;
· In case of trivial and build-up of intoxication, cyanosis, DN, shock stun;
Spirography - additional help in assessing dyshalny mobility, steps of disordered mental health, blood loss, liver and nerve deficiencies.

diagnostics

Switching of the main and additional diagnostic entries:

The main (obov'yazkovy) diagnostics of the condition, which is carried out on an outpatient basis:
· UAC;
OAM;
· Biochemistry analysis of blood (zagalny bilok, sechovina, creatine, bilirubin zalny, ALT, AST, glucose);

· EKG for viklyuchennya heart pathology;
· Oglyadova radiography of the organs of the breast cell (UD-V);
· Contrast roentgenography (fluoroscopy) to the duct and slunk from the bar (in the position of standing);
EFFGS (UD-V).

Dodatkovi diagnostics of the situation, which is carried out on an outpatient basis:
· CT of organs of the breast;
· Ultrasonic inspection of a carriage empty.

A minimal change in obsozhennya, which is necessary to carry out when directed to a planned hospitalization: according to the internal regulations of the stationary with respect to the orderly order placed by the body in the health protection.

The main (obov'yazkov_) diagnostics of the situation, which is carried out at a stationary(In case of emergency hospitalization, diagnostics are carried out, but not carried out on an outpatient basis):
· UAC;
OAM;
Biochemistry analysis of blood (gallbladder, albumin, sechovina, creatinine, bilirubin, ALT, AST, glucose, K, Na, Ca);
COAGULOLOGY (ACHTCH, PV, PTI, INR, fibrinogen A, fibrinogen B, an hour of blood circulation);
· Punctuation of the pleural emptying with the help of evacuation;
· Clinical and cytological analysis of punctate;
· Putting a punctate for viznachennya flory;
· Microbiological dosage of sputum (abo smear from zivu);
· Viznachennya sensitivity to antibiotics;
· Viznachennya group of blood behind the AB0 system;
· Viznachennya Rh factor blood;
· Blood analysis for VIL;
· Analysis of blood for syphilis;
· Viznachennya HBsAg in syrovattsі blood;
· Viznachennya total antibodies to hepatitis C virus (HCV) in syrovattsі blood;
EKG;
· Bronchoscopia;
· Fistulography;
· TS;
· Oglyadova radiography of the organs of the breast cell in two projections (UD-V);
· Spirography with the assessment of dyshal abilities.

Dodatkovi diagnostics of the situation, which is carried out at the stationary(In case of emergency hospitalization, diagnostics are not carried out on an outpatient basis):
· CT of the organs of the breast with the method of determining the width of the process, the connection with the organs and the middle, the interconnection (step of the recommendation - A);
· Diagnostic tests in cases of collapse, for atelectasis of the leg, due to the growth of mental deficiency, as well as for the drainage of pleural emptying, the introduction of anti-abdominal preparations, clotting of the fistula;
· Ultrasonic examination of organs in the black empty and small pelvis (in cases of manifestation of the small pelvis, vipot, picture changes in case of polyserositis);
· Ultrasound of pleural empty spaces (UD-V);
EFGDS with the presence of a tracheo or pleurisy-gastric fistula (UD-V);
· Oglyadova roentgenography of organs in empty and small bowl
EKG;
· EchoKG (vrahoyuchi localization of the lesion and the release of pathological vipot in the medical space and the emergence of the pericardial-pleural fistula);
· MRI of organs of a vole empty (in cases of fistula manifestation between pleural and void empty or an empty organ of a vole, as well as in case of peritonitis).

Diagnostics come in, which will be carried out at the stage of non-operational assistance: not carried out.

Instrumental doslіgennya:
· Oglyadova X-ray of the organs of the breast tissue: when the lungs become ill on the sick bots, it is empty, it is filled in by turns, with the horizontal line at the bottom. In case of chronic encapsulated pleurisy without fistula, the manifestation of homogeneous intensive pre-wall darkening with clear fissure edges is indicated;
· In case of fistulography, the boundaries, emptying, fistula manifestation, an analysis of the localization of emptying and the solution of other tactics is carried out;
CT scan of the breast tissue : the manifestation of a bent lung, age (deformity) and a lack of age in the pleural emptyness, change of organs in the middle to the healthy side, as well as the manifestation of heaviness, to move visually and to the structure of the com- yes, there is a possibility of a significant amount of money and the amount of planned operational involvement;
With bronchography, localization of the pathological process begins, ligaments with navkolishny tissues and empty ones, the stanchion of the bronchial tree is estimated;
· Pleural puncture in 7-8 mid-ribs along the middle line of the scapula along the upper edge of the lower rib, allowing to assess the character instead of emptying;
· Bronchoscopia allows you to visually accurately localize the purchase of pus, to carry out the sanitation of emptying and biopsies of the fight;
· TS additional help to assess the emptying capacity, the nature of the pleural growths, to identify the girdle of the pleurobronchial fistula and to precisely install the drainage.

Shown for consulting fahivts:
Consultation of a pulmonologist: on the basis of the level of DN, functional lung capacity, as well as preoperative antibacterial therapy.
Consultation of an anesthesiologist-reanimatologist: for nutritional information about operative treatment, preoperative preparation, vibration of the method of anesthesia.
Consultation with a cardiologist: for the prevention of mediastinum, for the prevention of the presence of a fistula and for the diagnosis before the operation, for the purpose of cardiotrophic and stimulating drugs in the case of a conservative method of treatment.
Consultation of an abdominal surgeon: in case of the presence of a noritsa move to empty organs cranial space for emptying itself, for conducting parallel conservative therapy or sanitation of emptying.
Consultation with a clinical pharmacologist: on the selection of adequate antibacterial therapy and administration, supernatural drugs until, before an hour, during the operation, and with a long treatment.
Consultation of a therapist: in case of manifestation of an apparent concomitant pathology.

Laboratory diagnostics

Laboratory Doslidzhennya:
· UAC: leukocytosis іf zsuvom leukocyte formula vlovo, SHOE up to 40-70 mm / year;
· Biochemical analysis of blood: hypoproteinemia for a decrease in the level of albumin, hypocholesterolemia, a decrease in the level of prothrombin, transaminase and fibrinogen;
· Out-of-the-box analysis of the section: to promote microhematuria, cylindruria, leukocyturia, bacteriuria, hypo-isostenuria.

Differential diagnosis

Differential diagnosis:

Table 1 Differential diagnosis EP

nosology	Characteristic syndromes / symptoms	differential test
pleurisy	Bil colecharacter, severity on the side of the strike, in the absence of the condition, dry cough, fibrous fever, seeing pus from the fistula on the chest wall.	CT - the manifestation of a hunched lung, the appearance of a bent lung, the appearance of a bent lung, and the appearance of a pleural empty space, a change in the organs of the middle to the healthy side, as well as the appearance of a heavy lung, is structured and frequent in the space.
serous pleurisy	Subfebrile temperature, difficulty in mental health, stupid b_l in chest cells, acrocyanosis.	Oglyadovaya roentgenography of the legends - inviolability of pleural lesions, lung litter in the healthy side, insight and intensity of exudate, visibility of gross deformable changes from the side of the pleural empty space.
caseous pneumonia	Virazheni syndrome of intoxication and broncholegenesis manifest illness. temperature is up to 39-40 ° С, post_yna. Appetite is also lost to anorexia, dyspepsia, and decreased weight. Ailments scrying on the brute in the breasts, staggering, coughing with phlegm, innocently in a rusty coli, abo nasty character... Profuse pit, cyanoticity of shkirnykh curves.	X-ray picture: hostile to the whole part of it, or even easier and the process is bilateral, with the manifestation of a great number of caverns, destruction of the legend, a high standing of the dome with diaphragms
gangrene of the lung	temporal fever, Bіl in the chest, sluggishness, whiteness and cyanosis of shkіrnyh crooks, drinkability, progressive decrease in mass, clear vision of stinky wetness	Roentgenography of the legends - great darkening (emptying of uneven areas) in the boundaries of the part with a tendency to widen on the lower parts, or everything is easier. CT - in the great empty spaces there are fabrics of sequestered size. Microscopic dosage of sputum: ditric plugs, necrotic elements of light tissue, visibility of elastic fibers.
Abo rib fracture intercostal neuralgia	More hospitable character, will adapt with the dichanna, physically normal self-esteem, the visibility of the circulating class.	Radiography of the OGK - the manifestation of the structure of the rib (ribs); If analgesics are recognized, the symptoms of the day are indistinguishable.
Pathology stravohodu, CVS	Damage to heart rate, rhythm, pulse, cold pit, tachycardia, convulsive spasm, arterial vise leaps. In case of pathology stravohodu - dysphagia, zriguvannya or blues, more spasm in character, localized more in the mesogastrium or in mediastinum.	EKG, myography, follow-up to the duct with a radio-opaque probe or a pressure suspension, EFGDS. EhoKG.
piddiaphragmatic abscess	More often in the right side of the ribs, they self-relieve, fever can be seen, leukocytosis is low, without changing the formula.	Oglyadova radiography of the organs of the breast cage from the buried empty worms. CT scan - in order to determine the exact location of the pathological process in terms of the reduction to diaphragms and sounds of two empty ones.
Pukhlini middle, empty breast tissue (Young's sarcoma, PNET, mesothelioma, MTS in the pleura)	Pain can be infrequent, volatile, can be stopped by analgesics. Periodically, DNs are promoted in the presence of a large community of chickens and organisms. Pukhlinna іntoksikatsіya. Uncontrollable fever.	Biopsia - detection of chubby cells during thoracoscopy. Detection of pathological cells in the UAC, B / hack - change the level of feritin, LDH, LF.

Likuvannya beyond the cordon

Take a lykuvannya in Korea, Izrail, Nimechchin, USA

Otrimati the consultation on medturism

lykuvannya

Cіlі lіkuvannya:
Usunennya dzherela zapalennya (eksudatu, pleural leaves, fistula);
· Normalization of blood indicators.

Likuvannya tactics:
· The main method of treatment of the EP is mistseve treatment (sanation of pleural emptying) (level of proof II, strength of recommendation - A);
· In case of confirmation of the diagnosis of the EP, it is shown that there is an extra treatment in the minds of the stationary with a cob of complex treatment;
· Pleural puncture due to the fence of material for bacteriological preliminaries and evacuation in place of the empty;
· Preoperative training in all types of patients, with a look at the risk of generalization process, for the implementation of the accelerated and minimization of the development of vital organs and tissues, as well as anesthesia treatment.

Hirurgic involvement:

Hirurgical involvement, which is to be repaired in outpatient minds- pleural puncture.

surgical involvement, which is to be repaired in stationary minds:
· Pleurectomy with lung decortication;
· Sanitation of pleural emptying;
· Anterior intubation of the prototypal head bronchus with total abo subtotal unilateral lesion.
Shown before the operation:
· Early TS at the time of the diagnosis, which reduces the risk of development of infectious diseases, generalization process, the involvement of structures in the process (the level of proof is III, the strength of the recommendation is B);
TT for a large amount of emptying, decortication and radical usunion in the sign of the onset of sanitation of pleural emptying in case of manifestation:
- running process abo adhesions і gross deformable changes in the chest;
- Svishcheva strokes.
Prototype shown before surgery:
· Deal with the viglyadі dissemination and generalization process;
· Sepsis;
· ІТШ;
· Double battle;
· DN vische of the III level.
Options for operational management:
· Thoracoscopy;
· Thoracotomy.
Test method (TT) Vikonutsya wide pathway along the mid-ribbed areas in 6-8 mid-ribs (one with 2-3 ribs resection) on the sides of the cut. The Danish type of operation with subtotal or total stripping, for easy access, maximum activity of surgical procedures, quick response and general resanction of half of the breast.
Zakritiy method (TS) to get stuck in case of more interconnected processes, encapsulated and burned, by means of puncture of 10 mm each in 2 to 5 trocars. In the case of practical access to technical specifications, it is possible to improve cosmetic results, reduce the triviality of hospitalization, change the speed of operation, and speed up renewal, as well as reduce the risk of recovery. (Strength of recommendation - B);
Vikoristannya zshivaє aparatu yes more over zhrittya kuksi parts of the lung or kuksi vіt lungs, nіzh vikorystannya traditional method. (Strength of recommendation - С);
Completion of the operation on the first overlays of the sutures is shown in all cases, if necroctomy was performed, during the formation of fistulas, as well as looking at the vice at the chest emptying. (I will prove it - II, the strength of the recommendation - B).
Draining of pleural emptying with the help of renewal of a vice in emptying, evacuation of excess vision (hemorrhagic serous, gnarous), for ease of access and introduction drugs, Evacuation of food is recommended in any form.
Rethoracotomy with repeated revision and sanitation is recommended for the occasion of the start of the operation period, for the determination of new conditions.

Non-drug treatment:
mode: mode 1 (post);
dієta: day 7 (bagata calories).

Drug treatment
Antibacterial therapy. In case of ignition of an operational wound and for the prevention of operational ignition processes, it becomes stagnant antibacterial drugs... Cefazolin or gentamicin in case of allergy to b-lactates and vancomicin in case of emergence / high risk of occurrence of methicilin - resistant Staphylococcus aureus. Follow the Scottish Intercollegiate Guidelines and Int. Antibiotic prophylaxis for this type of surgery is strongly recommended. In the case of endoscopic vision of ITT with the use of antibiotic prophylaxis, one of the lower-prescribed drugs ... In case of diagnostics of gland-ignition, the acceleration of the transfer of antibiotics (2-3) of antibiotics from other groups. The change in antibiotics for perioperative prophylaxis is guilty of conducting microbiological monitoring in the hospital.

Analgesic therapy. Non-narcotic and narcotic analgesics (tramadol or ketoprofen or ketorolac; paracetamol). The oil refinery is prescribed orally for pain relief. The oil refinery plant, with the help of pislyoperats_nogo zeniebolyuvannya, should be repaired 30-60 minutes before the end of the operation internally. It is not shown internally in the introduction of the refinery for the operation of the disease through the smallness of the concentration of the drugs in the synovial blood and in pain, viciousness in the blood, and in the form of ketorolac (can be administered internally). The refinery is contraindicated for patients with irregular lesions and bleeding shlunkovo-intestinal tract in the anamnesis. In the given situation, paracetamol will not be infused with the drug Vibor, but it is not infused into the mucus of the intestinal tract. Do not go to combine oil refineries with yourself. The combination of tramadol and paracetamol is effective.

Drug treatment, which can be repaired on an outpatient basis: not carried out.

Drug treatment, which is repaired on a stationary basis:

P / p No.	name INN	dose	multiplicity	way of introduction	triviality of liking	note	UD
1	morphine hydrochloride	1% -1 ml	through skin 6 years	in / m	1-2 days		V
2	Trimeperidin	2% - 1 ml	through skin 4-6 years	in / m	1-2 days	Narcotic analgesic, for antibiotic pain in the operative period	V
3	ketoprofen	300 mg, supplemental - 150-200 mg / day 100 mg 100-200 mg in 100-150 ml 0.9% solution to sodium chloride	2-3 times	in the middle in / m	2-3 days	non-narcotic analgesic	A
4	ketorolac	10-30 mg,	4 times / day (skin age 6-8 years)	i / m, i / v, in the middle	not more than 5 days, 2 days for children, in the middle no more than 5-7 days.	Non-narcotic analgesic for the treatment of gostrich and severe pain	A
5	tramadol	100 mg - 2 ml	2-3 times	in / m	stretching 2-3 days	Analgesic of a low type of diya in the operative period	A
6	ampicilin	0.25-0.5 g (old age), 0.25-0.5 g	4-6 times for doba skin 6-8 years	in the middle, in / m	from 5-10 days up to 2-3 times and more	Antibiotic of a group of napivsynthetic penicilines of a wide spectrum	A
7	ceftazidime	0.5-2 g	2-3 times for doba	i / m, i / v	7-14 days	3rd generation cephalosporin	A
8	ceftriaxone	1-2 m abo 0.5-1 g	1 time / day 2 times / day	i / m, i / v	7-14 days	3rd generation cephalosporin	A
9	cefotaxime	1 g 1d in important drops	2 times a day 3-4 times	i / m, i / v	7-14 days	3rd generation cephalosporin	A
10	Cefepim	0.5-1 g up to 2 g (for important infections	2-3 times	i / m, i / v	7-10 days and more	Cephalosporin of the 4th generation	A
11	cefoperazone	2-4 g (adult), with important infections: 8g (adult); 50-200 mg / kg (Children)	2 times / day	i / m, i / v	7-10 days	3rd generation cephalosporin	A
12	amikacin	10-15 mg / kg.	2-3 times	i / v, i / m	with intravenous injection - 3-7 days, with intravenous injection - 7-10 days.	Antibiotic - aminoglikosidi	A
13	gentamicin	0.4 mg / kg, 0.8-1 mg / kg for important infections	2-3 times	i / v, i / m	7-8 days	Antibiotic - aminoglikosidi	V
14	ciprofloxacin	250mg-500mg	2 times	in the middle	7-10 days		V
15	levofloxacin	250-750 mg 250-750 mg	1 time for doba	in the middle, intravenously drip slowly every 24 hours (a dose of 250-500 mg should be administered with a stretch of 60 minutes, 750 mg - with a stretch of 90 minutes).	7-10 days	When the function is damaged, it is necessary to correct the mode of introduction	A
16	meropenem	500 mg, with internal carnial infections - 1 g	Skin 8 years	i / v	7-10 days	Antibiotics - carbapenemi	A
17	azithromicine	500 mg / day	1 time for doba	in the middle	3 days	Antibiotic - azalidi	A
18	clarithromicin	250-500 mg each	2 times for doba	in the middle	10 days	Antibiotics-macrolide	A
19	metronidazole	500 mg,	Skin 8 years	in the middle intravenous (struma) or drip introduction - 5 ml / min.	7-10 days	Antibacterial agent	V
20	fluconazole	150 mg	1 time for doba	in the middle	one-time	Antifungal zasib, for the prevention and treatment of mycosis	A
21	Nadroparin	0.3 ml	1 time for doba	i / v, s / c	7 days	Direct anticoagulant (for the prevention of thrombosis). MAYPOSILYUVATISYA COMBINATION ABOUT ANOTHER ANTIBIOTIC AFTER THE OPERATION	A
22	Povidone - iodine	10% difference	today	zvnishno	According to the need	Antiseptic, undiluted solution for cleaning small curvatures, diluted drainage systems in 10 or 100 times	V
23	chlorhexidine	0,05% water breakdown		zvnishno	one-time		A
24	ethanol	razchin 70%;		zvnishno	one-time	Antiseptic for cleaning the operative field, hands of the surgeon	A
25	Peroxide	3% difference		zvnishno	According to the need	antiseptic for treatment	V
26	Sodium chloride	0.9% - 400ml	1-2 times	IV drip	in the presence of evidence	Rozchini for infusions, regulator of water-electrolyte balance and KShchS	A
27	dextrose	5%, 10% - 400 ml, 500 ml; rozchin 40% in ampoules 5 ml, 10 ml	1 time	IV drip	in the presence of evidence	Roschin for infusions, for hypoglycemia, hypovolemia, intoxication, dehydration	A
28	Aminoplasmal	10% (5%) breakdowns - up to 20 (40) ml / kg / day	1 time	IV drip	in fallowness to the camp of the sick	Means for parenteral opitania	B
29	Infezol	rozchin for infusions, 10-25ml / kg oil	1 time	IV drip	for weddings	pick up for parenteral feeding, Bilki and amino acids	V

Medication for treatment, which is to be repaired at the stage of high-quality non-emergency help: Not carried out.

Інші vidi lіkuvannya, huadayut at the stationary іvnі:
· UHF;
· Magnetotherapy;
· Electrophoresis;
· Bioptron.

Indicators of efficiency of treatment:
· Visibility of the EP class (at conservative lіkuvannі);
· Burning of the operative wounds with the primary interference, the appearance of the signs of the burning of the operative wound in the early period of the operative period and the fistula in the second period;
· The appearance of fever, pain and other symptoms, which may lead to an increase in the duration of the period of operation.

Preparations (such as speech), which can become stagnant during treatment

Azithromycin (Azithromycin)
Amikacin (Amikacin)
Aminoacids for parenteral nutrition + Other medicines (Multimineral)
Ampicillin (Ampicillin)
Hydrogen peroxide
Gentamicin
Dextrose
Ketoprofen (Ketoprofen)
Ketorolac
Clarithromycin
Levofloxacin
Meropenem
Metronidazole (Metronidazole)
Morphine
Nadroparin calcium
Sodium chloride
Povidone - iodine (Povidone - iodine)
Tramadol (Tramadol)
Trimeperidin (Trimeperidine)
Fluconazole (Fluconazole)
Chlorhexidine
Cefepime
Cefoperazone
Cefotaxime
Ceftazidime
Ceftriaxone
Ciprofloxacin (Ciprofloxacin)
Ethanol

hospitalization

Shown for hospitalization due to the designated type of hospitalization.

Indicated for the emergency hospital:
· Implants diagnoses: gostra empієma pleurisy;
· Obruntovane pripuschennya about the appearance of the EP.

Indicated for planned hospitalization:
· A mill for unsuccessful conservative therapy for pleurisy, croupous pneumonia, hydro-, pneumothorax (after 2 years of writing, the X-ray picture of the lesions).

prophylaxis

professional come in

Secondary prevention: early diagnosis, prompt hospitalization and prompt treatment.

Further information:
· Early activism on the day of the operation, for the first time.
· Enteral food - drinking from the first dobi, little bitch - with the appearance of intestinal peristalsis and the appearance of gases. Polypsy of mental activity, misinterpretation.
Vityag probe(In times of installation) - on the day of the operation.
· Carrying out of infusion therapy, antibacterial therapy, treatment of supportive illnesses for indications.
· Prevention of thromboembolic acceleration and damage of microcirculation of LMWH.
· The visualization of the control drainage - by 2-4 additional at the time of the day there is a decrease in the number and serous volume.
· Paying the shv_v from the operative wounds for the vehicle - for 5 dobu, for the TT - for 10-12 dobu.
· In case of an unrelenting interruption of the operational period, the vipisk should be carried out for 1-2 days for the vipisk from the stationary, at the end of the term it will be seen from the robot and the introduction of the initial mortgages.
· Beasts of respect for the appearance of symptoms - feverishness, badness, weakness, cough, pains, vidіlennya sputum.
· Inspection of the wound for vision and heat.

information

Dzherela and Literature

Protocols to send the Expert for the sake of RCHRH MHSD RK, 2015
1. List of vicarious literature: 1) Yu.F. Isakov, E. L. Stepanov, V. I. Geraskin - Certificate of Thoracic Surgery for Children, C 164 - 167, Moscow 1978. 2) Dovidnik for likars "Clinical surgery" edited by Yu. M. Pantsirev, S 125-128, Moscow 1988 3) P. N. Napalkov, A. V. Smirnov, M. G. Schreiber - surgical ailments, З 142-147, Moscow 1976r. 4) Operational surgery i topographic anatomy Edited by V.V. Kovanov, pp. 312-318. Moscow 1978r. 5) Bisenkov L.N. - Thoracic surgery, 2004r. 6) Struchkov V.I., Pugachov A.G. - Child thoracic surgery, 1975r. 7) Kolesnikov I. S. - Gangrene of the lung ipopneumothorax, 1983r. 8) Bakulev A.N., R.S. 9) V.K. Gostishchev - Operational surgery, 1996r. 10) Spasokukotskiy S.I. 1938; Kolesov V.I. 1955; Struchkov V.I., 1967, Lukomskiy G.I. 1976; Kabanov O.M., Sitko L.A. 1985.11) www.http: //free-medbook.ru 12) www.med.ru/patient/diseases/353 13) www.http: //diseases.academic.ru/1168

information

List of list of protocols in the protocol based on the qualifications of the qualifications:
1) Eshmuratov Temur Sherkhanovich - Candidate of Medical Sciences, AT "National Science Center of Surgery IM. A.N. Sizganova "patron of the Head of the government.
2) Zharilkapov Nurlan Serikovich - Candidate of Medical Sciences, AT “National Science Center of Surgery IM. A.N. Sizganova ", a license for the development of thoracic surgery.
3) Kolos Anatoly Ivanovich - Doctor of Medical Sciences, Professor, AT "National Science medical center", the leading scientific scientist.
4) Medeubekov Ulugbek Shalkharovich - Doctor of Medical Sciences, Professor, AT "National Science Center of Surgery IM. A.N. Sizganova ", the defender of the head of the government of scientific and clinical robots.
5) Satbaeva Elmira Maratovna - Candidate of Medical Sciences, RSE at the REM “Kazakh National Medical University imeni S.D. Asfendiyarova "Head of the Department of Clinical Pharmacology.

Conflict of interests:Відсутнє.

reviewer:
1) Pischik Vadim Grigorovich - Doctor of Medical Sciences, Professor, Chief Thoracic Surgeon in St. Sokolov.
2) Tuganbekov Turlibek Umitzhanovich - Doctor of Medical Sciences, Professor, AT “Med. Astana University "Head of the Department of Surgical Ailments No. 2.

Take a look at the protocol: re-examination of the protocol through 3 years of writing and publishing and from the date of joining the show, or if new methods are evident with a high level of proof.

Attached files

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