慢性缩窄性心包炎行心包剥脱术的预后及危险因素:单中心二十年经验  

Prognosis of pericardiectomy in patients with constrictive pericarditis and its associated risk factors: single center's 20-year experience

作　　者：李汉美[1] 佟明汇 王巍[1] 杨研[1] 董超[1] Li Hanmei;Tong Minghui;Wang Wei;Yang Yan;Dong Chao(Department of Cardiac Surgery,Fuwai Hospital,National Center for Cardiovascular Disease,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院成人外科中心,北京100037

出　　处：《中国体外循环杂志》2018年第3期160-164,共5页Chinese Journal of Extracorporeal Circulation

摘　　要：目的本研究旨在报道本院缩窄性心包炎患者行心包剥脱术后的远期随访结果,并分析影响预后的危险因素。方法回顾性分析自1997年1月至2016年12月在阜外医院因慢性缩窄性心包炎行心包剥脱术共297例患者的临床资料,对所有患者进行术后随访及统计分析。结果患者年龄在3.7~83(41.8±16.1)岁,女性患者81例(27.3%),NYHA心功能Ⅳ级41例(13.8%),术前合并房颤140例(47.1%),既往接受过心包剥脱术70例(23.6%),结核性心包炎有182例(61.3%),特发性心包炎有99例(33.3%)。本次手术剥脱完全者281例(94.6%),体外循环下手术48例(16.2%),21例患者同期接受了二尖瓣或三尖瓣手术。手术死亡13例,手术死亡率4.4%(其中非体外循环下手术249例,死亡7例,死亡率2.8%;体外循环下手术48例,死亡6例,死亡率12.5%)。平均随访55.7月,失随访38例(12.8%),随访中死亡13例。手术时年龄、术前房颤及再次心包剥脱术是影响患者主要不良心脑血管事件的危险因素,而再次心包剥脱术是影响患者远期生存率的唯一独立危险因素OR=4.03(1.5-10.5)。结论缩窄性心包炎行心包剥脱术治疗安全有效,再次心包剥脱术是影响预后的独立危险因素。Objective Pericardiectomy is associated with poor survival and its long term prognosis remains unclear.We aimed to review the 20 years of experience on pericardiectomy in our center and to investigate the prognosis and risk factors after pericardiectomy in patients with constrictive pericarditis. Methods Preoperative clinical and imaging characteristics were evaluated in 297 consecutive patients with chronic constrictive pericarditis who underwent pericardiectomy between January 1997 to December 2016. Demographic comorbidity,operative data,and follow-up outcomes were analyzed. Results Patients were aged 3.7-83 years old（ 41.8± 16.1）.There were 81 females（ 27.3%）.Etiology included idiopathic（ n = 99,33.3%）,postoperative（ n = 4,1. 3%）,postradiation（ n = 2,0.7%）,and tuberculosis（ n = 182,61. 3%）. Complete pericardiectomy was performed in 281 patients. There were 13 perioperative deaths.The 5-year,10-year,20-year survival rates were 89.5%,88.4% and 84.1%,respectively.195 patients（ 65.7%） remained event free by the end of follow-up. Multivariate Cox analysis showed that re-do pericardiectomy（ hazard ratio 4.03（ 1.5-10.5）,P =0.01） was the risk factor for increased long-term mortality. Age（ P 〈0.01,HR： 1.02（ 1.01-1.04））,preoperative atrial fribillation（ P〈0.01,HR2.28（ 1.40,3.71））,re-do pericadietomy（ P = 0.02,HR1.92（ 1.1-3.3）） emerged as risks of long-term event-free survival. Conclusion Re-do pericadietomy was an independent risk factor of poor prognosis after pericardiectomy.Complete pericardiectomy is a safe and reliable treatment for patients with constrictive pericarditis.

关 键 词：慢性缩窄性心包炎 心包剥脱术 预后 危险因素 

分 类 号：R654.2[医药卫生—外科学]