缩窄性心包炎的诊断和手术治疗  

Diagnostic and surgical experiences of constrictive pericarditis

作　　者：朱家全[1] 曾文辉 张俊文[1] 黄健兵[1] 鲍春荣[1] 丁芳宝[1] 梅举[1] ZHU Jia-quan;ZENG Wen-hui;ZHANG Jun-wen(Department of Cardiothoracic Surgery,Shanghai Xinhua Hospital,Shanghai Jiaotong University,School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院心胸外科

出　　处：《中国心血管病研究》2018年第10期924-928,共5页Chinese Journal of Cardiovascular Research

基　　金：国家临床重点专科项目;国家自然科学基金(项目编号:81600219);新华医院临床重点基金(项目编号:15LC03)

摘　　要：目的总结我院近年来缩窄性心包炎的治疗经验，重点探讨心包增厚不明显患者的诊治。方法回顾性分析我科2005—2018年11例行心包剥脱手术的缩窄性心包炎病例。总结患者症状、心电图、胸部CT和超声心动图表现，并介绍近年来采用的针对缩窄性心包炎的超声心动图、心导管和磁共振检查经验。结果本组患者中位年龄35岁，术前结合CT和超声心动图提示心包增厚10例，但有1例心包增厚不明显。该病例超声心动图发现室间隔抖动、室间隔运动随呼吸改变、二尖瓣过瓣血流、瓣环运动改变；心导管检查发现静脉压增高，有心室压力呈“平方根”波形；心脏磁共振提示有心室管样结构，伴左右心室舒张末容积指数下降；该患者接受了心包剥脱术，术中确诊。全组无死亡及围术期严重并发症，术后中心静脉压显著下降；呼吸机使用11．5h，ICU停留3．2d，术后住院12d，随访无复发、死亡。结论少数缩窄性心包炎患者心包增厚可能不明显，需行针对性的超声心动图、心导管和磁共振检查。慢性缩窄性心包炎的手术治疗效果良好。Objective This study summarized our experiences of this disease and focused on the management of those who without thickened pericardium. Methods CP patients from 2005 to 2018 who underwent pericardiectomy were retrospectively reviewed. The findings of electrography, echocardiography and CT scan were collected. In addition, and the recent diagnostic modalities, including specific echocardiogram with constriction-protocol, catheterization and MR were introduced. Results The median age was 35 years old, and thickened pericardium was found in 10 patients by the combination of echocardiography and CT scan;however, one patient presented without thickened pericardium. The echocardiographic constriction-protocol was performed, and we found ventricular septal bounce, with septal shift during respiratory cycle. Flow pattern through mitral valve and hepatic vein also changed with breath. The catheterization found elevated central venous pressure, and ＂square root＂ like right ventricular pressure. Cardiac MRI revealed morphological change of right ventricle （tubelike）. This patient received operation later, and was confirmed the diagnosis. There was no perioperative death or severe complications. The central venous pressure significantly decreased after the operations. The average ventilation time was 11.5 hours, and ICU stay of 3.2 days. Postoperative in-hospital stay was 12 days, and there was no recurrence or death during the follow up. Conclusion A few patients of constrictive pericardium do not have significant thickened pericardium. In such circumstance, special echocardiogram with CP protocol, catheterization and cardiac MRI can help the diagnosis. The operative outcomes of pericardiectomy in chronic CP were satisfied.

关 键 词：缩窄性心包炎 心包剥脱术 舒张性心力衰竭 

分 类 号：R654.2[医药卫生—外科学]