Abstsediruyushchy pneumonia is the destructive inflammatory process which is followed by formation of the multiple purulent centers in pulmonary fabric. The symptomatology varies depending on the activator. Classical displays of abstsediruyushchy pneumonia include febrilny temperature, oznoba, heavy intoxication, cough with a fetid phlegm, anorexia, loss of weight. The X-ray analysis and KT of lungs act as the confirming methods of diagnostics. In treatment of abstsediruyushchy pneumonia medicamentous methods (antibiotics, infusional therapy, an immunotherapy), impact on the infection center (sanatsionny bronkhoskopiya, ), extracorporal haemo correction are combined (Ural federal district blood, haemo sorption).
Abstsediruyushchy pneumonia is the complication of pneumonia of various etiology which is characterized by education intra pulmonary is purulent - necrotic cavities. In pulmonology the term "abstsediruyushchy pneumonia" designates the period during pneumonia during which against the background of infiltrative changes clinical and radiological signs of destruction of a pulmonary parenchyma are defined. Conditional difference of abscess of a lung from abstsediruyushchy pneumonia it is considered to be the size of a purulent cavity: in the first case its diameter exceeds 2 cm. If in pulmonary fabric there are small and multiple centers of destruction or a solitary cavity with a diameter less than 2 cm, speak about abstsediruyushchy pneumonia. Most often bacterial and aspiration pneumonia is complicated by suppuration.
In an etiology of abstsediruyushchy pneumonia the predominating role belongs to golden staphylococcus, a klebsiyella of pneumonia (Friedlander's stick) and other enterobakteriya; the pneumococcus and a hemolytic streptococcus, anaerobic bacteria become slightly more rare activators (fuzobakteriya, peptostreptokokk). These microorganisms are capable to cause destruction and a necrosis of pulmonary fabric with the subsequent formation of a limited purulent cavity.
As the major factors promoting hit of activators in pulmonary fabric serve aspiration of a significant amount of a secret of a rotoglotka and existence in an organism of the purulent centers contacting to the blood or lymphatic course. The aspiration mechanism of developing of abstsediruyushchy pneumonia is most often observed at the persons having alcoholism and drug addiction, epilepsy, a stroke, consciousness violations, a dysphagy, GERB, etc. The metastatic hematogenic or limfogenny abstsedirovaniye of lungs, as a rule, is a consequence of a heavy furunkulez, an endocarditis, osteomyelitis. Foreign matters of bronchial tubes, tumors of lungs can be the possible reasons of an abstsedirovaniye. Patients with abstsediruyushchy pneumonia in the anamnesis often have instructions on background pathology (blood diseases, diabetes, periodontosis), long-term treatment by glucocorticoids and cytostatics.
In pathogenesis of abstsediruyushchy pneumonia the greatest significance is attached to a specific class of the activator with its anti-gene properties, sensitivity of a microorganism to antibiotics, associated diseases of the airways and an organism in general breaking local and general reactivity. Destruction of pulmonary fabric is connected with the fact that pathogens (in particular staphylococcus) develop a large amount of the enzymes and toxins possessing cytolytic action and causing a necrosis of alveolar partitions. It leads to formation of the multiple cavities filled with air and serous and hemorrhagic exudate, which do not have a clear boundary around the disintegration centers. Further these cavities can or evolve in the large purulent center (lung abscess), or to merge, giving rise to abstsediruyushchy pneumonia.
Symptoms of abstsediruyushchy pneumonia
In most cases the beginning of a disease a little in what differs from usual focal pneumonia. The patient is disturbed by cough, fever, thorax pains with a tendency to strengthening at breath; radiological focal infiltration in lungs is defined. At children accession of abdominal, neurotoxic or astmoidny syndromes is possible.
Under adverse conditions the state quickly worsens and at the following stage actually abstsediruyushchy pneumonia develops. This stage is followed by increase of symptoms of intoxication (a hyperthermia to 40 °C from oznoba, adinamiya, anorexias) and respiratory insufficiency (short wind with participation of auxiliary muscles in the act of breath, cyanosis). As at this time in pulmonary fabric microabscesses are already formed, emergence of a phlegm with a putrefactive smell, sometimes with blood impurity is noted. The patient is adynamic, slowed down; integuments of pale gray coloring; confusion of consciousness can be noted. At further development of a disease there is abscess of a lung during which distinguish stages of formation and drainage of an abscess.
Treat number of the local purulent complications burdening an outcome of abstsediruyushchy pneumonia an empiyema of a pleura, , mediastinit. Metastasis and generalization of an infection lead to development of a bacterial perikardit, purulent arthritis, sepsis, etc. The investigation of a partial or full obturation of a bronchial tube can be a lung. At an erozirovaniye of vessels there is a risk of developing of pulmonary bleeding. At extremely rapid and heavy current of septic pneumonia development of the polyorgan insufficiency demanding performing intensive therapy is possible.
Fizikalny data are characterized by weakening of breath, shortening of a perkutorny sound, existence of damp rattles, , tachycardias. In blood tests – signs of the expressed system inflammation (considerable , increase in SOE, SRB). A fundamental role in establishment of the diagnosis is played by results of radiological inspection. At the same time, the standard X-ray analysis of lungs not always allows to visualize small band educations against the background of pneumonic infiltration. Therefore at suspicion of abstsediruyushchy pneumonia it is expedient to resort to carrying out KT of a thorax. In case of formation of abscess of a lung in pictures thick-walled band education decides on presence of characteristic level of liquid and gas.
Within differential diagnosis, an exception of tuberculosis and lung cancer it is carried out triple a phlegm research on VK (causative agents of tuberculosis) and atypical cages. For allocation of pathogenic flora it is carried out a phlegm or washing waters of bronchial tubes with definition of an antibiotikochuvstvitelnost. In some cases for clarification of the reasons of abstsediruyushchy pneumonia carrying out a diagnostic bronkhoskopiya is shown.
Treatment of abstsediruyushchy pneumonia
Abstsediruyushchy pneumonia will difficult respond to treatment and demands a combination of methods of therapeutic and surgical influence. Etiotropny therapy is based taking into account sensitivity of the allocated pathogens to antibacterial means. Its duration can make from 4 weeks to several months; the question of change and a combination of medicines is solved the pulmonologist individually, taking into account kliniko-radiological dynamics. Usually as starting therapy of abstsediruyushchy pneumonia benzylpenicillin + metronidazole, linkozamida (, lincomycin), aminopenicillin (amoxicillin / to - that, ampicillin / ), etc. are used.
For the purpose of improvement of a drainage of the purulent center expectorant, mukolitichesky, bronkholitichesky medicines, medicinal inhalations are appointed. Patients with abstsediruyushchy pneumonia need careful leaving, high-calorific food with completion of loss of protein. At the expressed gipoproteinemiya parenteral introduction of albumine, plasma is carried out. For a detoxication the gravitational surgery of blood is used (a plasma exchange, Ural federal district blood, haemo sorption). Correction of respiratory insufficiency, a gipovolemiya, violations of water and mineral balance is at the same time carried out. At the confirmed staphylococcal etiology of abstsediruyushchy pneumonia introduction of hyperimmune anti-staphylococcal plasma is effective.
For the purpose of sanitation of the purulent centers medical bronkhoskopiya are used, according to indications the puncture or drainage of abscess with active aspiration of pus, washing of a cavity antiseptic solutions, introduction of proteolytic enzymes and antibiotics is carried out. In case of impossibility of conservative treatment of abscess the resection of the struck departments of a lung is shown.
Forecast of abstsediruyushchy pneumonia serious; lethality of high 15–25%. At emergence of complications, existence of associated diseases and the centers of a purulent infection the percent of failures is significantly higher. The course of abstsediruyushchy pneumonia can come to an end with recovery, formation of fibrosis of slight, chronic abscess of a lung.