非典型结核性缩窄性心包炎诊疗结果分析  

Explore the diagnosis and treatment characteristics of atypical tuberculous constrictive pericarditis

作　　者：张建[1] 刘达兴[1] 梁贵友[1] 汤全[1] 周浩[1] ZHANG Jian;LIU Daxing;LIANG Guiyou(Department of Cardiovascular Surgery,Affiliated Hospital of Zunyi Medical College,Guizhou Province,Zunyi 563003,China)

机构地区：[1]遵义医学院附属医院心血管外科,贵州省遵义市563003

出　　处：《临床合理用药杂志》2018年第25期17-19,共3页Chinese Journal of Clinical Rational Drug Use

基　　金：贵州省科技合作计划(No:黔科合LH字[2015]7500号)

摘　　要：目的分析非典型结核性缩窄性心包炎诊疗特点,为临床诊疗提供依据。方法选取结核性缩窄性心包炎158例。根据术前CT评价心包增厚、钙化表现将病例分为研究组(非典型缩窄性心包炎)34例和对照组(典型缩窄性心包炎124例)。分析2组患者病史特点及诊疗结果。结果术前研究组发病时间短于对照组,心功能分级低于对照组,差异有统计学意义(P<0.05);2组性别、年龄、肘静脉压、心房纤颤及LVEF水平比较差异无统计学意义(P>0.05)。研究组中2例经开胸后明确为限制性心脏病,系误诊病例,其余患者均顺利完成手术。术中发现研究组病例心包粘连严重、剥脱困难,而采取"井"字划痕松解的病例多于对照组(P=0.001)。在术后6~12月的随访发现:研究组LVEF改善低于对照组,而术后利尿剂依赖率及症状复发均高于对照组,差异有统计学意义(P<0.05)。2组手术时间、术后肘静脉压、术后心功能分级水平比较差异无统计学意义(P>0.05)。结论非典型结核性缩窄性心包炎易误诊,心包致密粘连不易剥脱,术后疗效差,症状易复发,需要临床重视,而把握其最佳的手术时机才能获得较好治疗效果。Objective To explore the diagnosis and treatment characteristics of atypical tuberculous constrictive pericarditis in order to provide evidence for clinical diagnosis and treatment. Methods Selected 158 cases patients with tuberculous constrictive pericarditis. According to the preoperative CT evaluation of pericardial thickening and calcification,the patients were divided into the study group（ atypical constrictive pericarditis） 34 cases and the control group（ typical constrictive pericarditis 124 cases）. Compared the characteristics of the medical history and the results of diagnosis of 2 groups. Results The onset time of study group was shorter than that of control group,the heart function classification of study group was lower than that of control group,the difference was statistic significant（ P〈 0. 05）; The gender,age,varicose vein pressure,atrial fibrillation and LVEF levels of 2 groups was no statistic significant（ P 〉0. 05）. In the whole group,2 cases were clearly restricted heart disease after thoracotomy,which was misdiagnosed,and the other patients successfully completed the operation. 2 cases of misdiagnosis were from the study group; The severe pericardial adhesions,stripping difficulty,＂#＂scratches of study group were more than that of control group（ P = 0. 001）. Follow-up from 6 to 12 months after surgery found that The LVEF improve situation of study group was lower than that of control group,and the diuretic dependence rate after postoperative and symptom recurrence rate were higher than of control group（ P〈 0. 05）. The surgical time,elbow venous pressure and cardiac function grading after postoperative was no statistic significant（ P〉 0. 05）. Conclusion Atypical tuberculous constrictive pericarditis is easily misdiagnosed,pericardial adhesion is not easy to exfoliate,postoperative curative effect is poor,symptoms are easy to relapse,need clinical attention,and grasp the best surgical timing to get better therapeutic effect.

关 键 词：结核 缩窄性心包炎 诊疗结果 

分 类 号：R542.11[医药卫生—心血管疾病]