Gangrene of lung

The gangrene of lung is necrosis of pulmonary tissues under act of toxins and violation of feed, which does not have clear borders. Between the acute abscess of lung and gangrene of lung a lot in common, but, nevertheless, most authors consider these diseases independent. At AAL the inflammatory reaction and purulent focus has the limited character, and at the gangrene of lung is necrosis of pulmonary tissues, have not clear borders. At the gangrene of lung a necrotic process spreads in pulmonary tissues diffusely. The areas of normal tissues without noticeable borders pass to changed, losing a clear structure pulmonary tissues which also without clear borders.. Thus pulmonary tissues have the appearance of grey-green mass with foul smell. Usually is affected lobe, two lobes or all lung. Polymicrobe floras are the origin affectation of lung: staphylococci, gram-negative bacterias and different anaerobes. The supporting factors in appearance of gangrene are disorder of passage in bronchus with evolution of atelectasis, disorder of blood circulation; creation of the reserved space in the area of atelectasis and stopping of clearing of bronchial tubes from an infection by expectoration; and, especially, influence of a plenty of toxins of developing microorganisms on tissues of lung

Clinic of gangrene of lung

All above mentioned, what are regard to the acute abscess of lung, belongs and to the gangrene of lung with that only a difference, that acute intoxication of organism of patient comes on the first place. The disease is accompanied constantly by a high temperature, which does not lowering long time, or has vibrations, in the morning and in the evening. A painful cough with especially foul sputum is characteristic.

Sputum has the appearance of foamy liquid, dirtily-grayish color, sometimes with the raspberry or chocolate coloring which is explained by the parenchimatose bleeding from disintegrating tissues. At precipitation the sputum divides on 3 layers: upper is liquid, middle is serous, lower is dense, consisting of granulated mass and fragments of pulmonary tissues. A plenty of sputum is usually expectorated at mornings and is accompanied by a excruciating cough.

Patients complain on several pains in the affected half of thorax. It is related to affectation of pleura, which is rich by the nervous endings.

The state of patients at the gangrene of lung is always heavy. They weaken quickly, is exhausted, sweating, absence of appetite, making progress anemia is marked.

At examination of patient lag of affected half of thorax is marked.

At percussion dullness of percutory sound with the unclear spreader borders is marked.

At auscultation there is a plenty of different calibers rales. A frequent and small pulse, deaf tone of hearts, lowering B/P is marked. At the beginning of disease leucocytosis with the change of leucocytes formula to the left side registers in a blood. As far as making progress of gangrene the lowering of leucocytosis is possible.

At roentgenologic research usually detected the intensive darkening of part of lung with gradual transition to the normal pulmonary picture on periphery..

If gangrene makes progress, and spreads on peripheral regions of lung, as result, parenchyma of lung disintegrates as sequesters and gets in a pleura cavity - develops the putrid pyopneumothorax and illness acquires the septic form.

Treatment of patients with the gangrene of lung.

Treatment at the gangrene of lungs is exact the same, as well as at the acute abscess of lung with that only a difference, that it must be more intensive.

Conservative treatment at GL is produced:

1) at the neglected forms of gangrene of lungs and expressed pulmonary-cardiac insufficiency and bilateral affectation;

2) if there is place of transformation of gangrenous abscess to ordinary acute abscess with adequate draining;

3) uncomplicated gangrene of lights with the favorable clinic-roentgenologic dynamics of on a background producible treatment.

In all other case conservative treatment at the acute gangrene of lungs must be examined as preoperative period.

Intensive therapy at GL includes infusion therapy with the purpose of parenteral feeding, corrections of water-electrolyte disorders, improvements of reologic properties of blood, supportion of energetic balance and desintoxication. Maintenance of energetic balance is here provided by introduction of the concentrated solutions of glucose 25-40% to 1 liter.

Restoration of albumin losses more frequent than all is performed by introduction of solutions of aminoacids, fresh-frozen plasma, solutions of albumin and other.

For desintoxication and improvements of reologic properties of blood, improvement of capillary circulation of blood use infusion of gemodese, reopolyglukine, reamberine.

For correction of anemia use transfusion of erythrocyte mass, best of all washed red corpuscles.

To the extremely heavy patients with the gangrene of lungs with the clinic of septic shock with the appearance of polyorgan insufficiency the combined therapy with the use of preparations influencing on the cellular regulation of antioxidant immune answer is indicated: cytoflavin for 10 mgs 2 times per days on of a 200 or 900 ml 5% or 10% solution of glucose with the subsequent joining of cycloferone 4 ml 2 times per days after stabilization of the state of patient. In heavy case indicated introduction of pentaglobine (USA) i/v 10 or 20 ml on a solvent 50 ml or 100 ml (contains valuable and biologically intact immunoglobulins in a stable form.

In the case of unsuccessful of conservative therapy patients with the gangrene of lungs are subject to operative treatment. The methods of surgical treatment divide by resections and draining. Draining operations are less traumatical. Draining can be executed by thoracocentesis and drain tube. Presently draining is executed with help thoracoscopy. It is possible drainage at the gangrene only cavity with liquid pus and small sequesters. During thoracoscopy pus is deleted, all sequesters, complete sanation is conducted. Nevertheless, if allows the common state of patient, the resection of lobe of lung, two lobes or deleting of lung – pulmonectomy are more radical.

Date: 2014-12-21; view: 1613