重症缩窄性心包炎外科治疗37例临床分析  

A clinical analysis of 37 patients with severe constrictive pericarditis who underwent surgery

作　　者：李海慧 刘以尧[1] 施超[1] 刘戈[1] 孟金金[1] 刁文杰 申国争 张娜娜[1] 石宇[1] 刘学刚[1] Li Haihui;Liu Yiyao;Shi Chao;Liu Ge;Meng Jinjin;Diao Wenjie;Sheng Guozheng;Zhang Nana;Shi Yu;Liu Xuegang.(Department of Cardiac Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Chin)

机构地区：[1]蚌埠医学院第一附属医院心脏外科,安徽省蚌埠市233004

出　　处：《中华解剖与临床杂志》2018年第2期126-130,共5页Chinese Journal of Anatomy and Clinics

基　　金：安徽省高校优秀青年人才支持计划重点项目（gxyqZD2016167）

摘　　要：目的 探讨重症缩窄性心包炎外科治疗策略.方法 回顾性分析2007年1月—2017年6月蚌埠医学院第一附属医院心脏外科收治的37例重症缩窄性心包炎患者的临床资料,其中男26例、女11例,年龄22～73（38.42±17.21）岁,病程3个月～5年.37例中,心源性恶液质12例,低心排血量综合征5例,严重贫血、低蛋白血症12例,严重肾功能不全2例、肝功能不全8例.术前中心静脉压16～35 cmH2O（1 cmH2O=0.018 kPa）,其中≥20 cmH2O 28例.心功能NYHA分级：Ⅲ级15例,Ⅳ级22例.患者均行心包剥脱术治疗.术后观察患者心功能恢复情况.结果 本组37例,术中死亡2例,其余患者均顺利完成手术.手术时间1.5～3 h,平均2 h.患者术后中心静脉压均〈20 cmH2 O,其中26例〈14 cmH2 O.35例患者中,术后并发低心排血量综合征5例,予强心、利尿处理,1例治疗无效死亡,4例好转;并发心律失常6例、急性肾功能不全3例、呼吸功能不全4例,予相应处理后,患者均好转.患者术后心功能均不同程度改善,出院时心功能NYHA分级Ⅰ级24例、Ⅱ级9例、Ⅲ级1例.34例获随访,随访时间0.5～10年,平均4.6年.术后3个月复查胸部CT示：心包手术区有无组织增生、钙化.随访期间患者无复发,基本恢复日常工作、生活.结论 重症缩窄性心包炎病情重,并发症多,应尽早确诊,积极手术治疗.同时,需加强围术期管理,制定合理治疗方案,术中精准把控心包切除顺序和范围,以提高手术成功率、降低术后并发症发生率.Objective To explore the surgical treatment strategy about severe constrictive pericarditis.Methods From January 2007 to June 2017, 37 patients with severe constrictive pericarditis who underwent surgical treatment were retrospectively analyzed in Department of Cardiac Surgery,the First Affiliated Hospital of Bengbu Medical College. Of the 37 patients, 26 were males and 11 were females. The average age was （38.42±17.21）years, range from 22 to 73 years old . The disease course ranged from 3 months to 5 years. There were 12 patients of cardiac cachexia, 5 patients of low cardiac output syndrome, 12 patients of severe anemia and hypoproteinemia, 2 patients of severe renal insufficiency and 8 patients of hepatic insufficiency. Preoperative central venous pressure was 16 to 35 cmH2O（1 cmH2O=0.018 kPa）, of which 28 patients were more than 20 cmH2O. New York Heart Association（NYHA） classification of cardiac function： 15 patients of class Ⅲ and 22 patients of class Ⅳ. Pericardial exfoliation was performed in all patients. The recovery of cardiac function after operation was observed.Results In this group of the 37 patients, 2 patients died during the operation, and the rest of the patients were successfully operated. The operation time was 1.5 to 3 h, with an average of 2 h. In all 37 patients, central venous pressure（CVP） dropped to less than 20 cmH2O after operation, of which 26 patients were below 14 cmH2O. Hypo-cardiac output syndrome occurred in 5 patients, 1 patient died, and 4 patients improved. There were 6 patients of arrhythmia, 3 patients of acute renal insufficiency and 4 patients of respiratory insufficiency. The clinical symptoms of the other 17 patients improved gradually after operation. Postoperative cardiac function was improved,NYHA classⅠ24 patients, classⅡ 9 patients, class Ⅲ 1 patient. The chest CT was reviewed after operation 3 months to observe that there was no calcification in the pericardial operation area. 34 patients were followed up for 0.5 to 10 years with the a

关 键 词：心包炎 缩窄性 重症 外科技术 围术期处理 

分 类 号：R654.2[医药卫生—外科学]