结核所致缩窄性心包炎的外科治疗  

Surgical treatment of constrictive pericarditis caused by tuberculosis

作　　者：郭家龙[1] 张军[1] 林称意[1] 季艳梅[1] 胡光柱[1] 左顺庆[1] 

机构地区：[1]湖北医药学院附属太和医院心胸外科,湖北十堰442000

出　　处：《中国现代医学杂志》2013年第10期69-71,共3页China Journal of Modern Medicine

基　　金：湖北省教育厅重点科研计划资助项目(No:D20092402)

摘　　要：目的总结分析36例结核所致缩窄性心包炎的外科治疗经验。方法回顾分析36例经外科手术治疗的结核所致缩窄性心包炎患者的临床资料,均采用正中开胸入路行心包剥脱术。结果该组1例死于术后顽固性低心输出量综合征,余者术后症状改善明显,中心静脉压全部降至14 cmH2O以下,超声心动图示左心射血分数正常,为(0.55±0.10);心功能多恢复至I、II级。心包病理结果示61.1%(22/36)具有结核病特征,38.9%(14/36)心包病理检查无典型结核改变。结论结核所致缩窄性心包炎病变发展较快,诊断明确后应及早手术,及时的心包剥除加术后强化抗结核治疗,可能对预后更加有益。[Objective] To summarize the experience with surgical treatment of constrictive pericarditis caused by tuberculosis. [Methods ] A retrospective analysis of the post-operative clinical data was conducted in 36 surgical patients with chronic constrictive pericarditis caused by tuberculosis. All of them underwent perieardectomy through median sternotomy approach. [ Results ] One early postoperative death occurred in this group due to refractoriness low cardiac output syndrome, the others had much better recovery from the operation. After the operation, the central venous pressure （CVP） declined to 14 cmH20 in all of them. Echocardiogram demonstrated cardiac ejection fraction of left ventricular recovered to a norm parameter （0.55~0.10）. The result of pericardium pathology showed that 61.1% （22/36） of them had tuberculosis characteristic, and 38.9% （14/36） had no typical tuberculosis change. [Conclu- sion ] Constrictive pericarditis caused by tuberculosis pathological changes was fast. Once it has a identify diagnosis, the operation should be performed as soon as possible. Perieardectomy promptly and reinforced anti- tuberculosis therapy postoperation may have a much better prognosis for the patients.

关 键 词：结核 缩窄性心包炎 外科手术 心包切除 

分 类 号：R542.11[医药卫生—心血管疾病]