心包剥脱术治疗缩窄性心包炎患者的近期疗效分析——单中心结果  

Short-term efficacy of pericardiectomy in patients with constrictive pericarditis:single-center results

作　　者：曹安强[1] 罗勇[1] 袁武[1] 程力剑 陈剑[1] 王伟[1] 赵龙 陈杰 CAO An-qiang;LUO Yong;YUAN Wu;CHENG Li-jian;CHEN Jian;WANG Wei;ZHAO Long;CHEN Jie(Department of Cardiovascular,The Third People′s Hospital of Chengdu,Chengdu Institute of Cardiovascular Disease,Chengdu 610504,China)

机构地区：[1]成都市第三人民医院成都市心血管病研究所心内科,成都610504

出　　处：《岭南心血管病杂志》2020年第4期424-428,共5页South China Journal of Cardiovascular Diseases

摘　　要：目的总结127例缩窄性心包炎外科患者的手术治疗经验及疗效,为缩窄性心包炎手术时机及治疗方法提供依据。方法收集2015年3月至2019年3月成都市第三人民医院完成心包剥脱术的患者127例,根据患者发病到术前的病程分为5组:3个月以内组,3~6个月组,6~12个月组,1~3年组,3年以上组;统计各组患者的人数比例、症状、体征、手术时间、术后并发生症发生率及预后,手术后医生满意度等指标,对缩窄性心包炎外科手术效果作一简单评价。结果127例均顺利完成手术,围术期死亡3例(2.36%)。随着病程时间的延长,患者术前症状及体征阳性率及严重程度增加;术后肺部并发症、低心排血量发生率有明显增加,尤其当病程超过3年后,低心排血量发生率较其他组有明显增加,住院时间明显延长。3~6个月病程组外科手术操作性差,心包组织残留率高,外科医生手术满意度最差。结论胸骨正中切口是心包剥脱术的最佳切口选择;术前针对性的强心治疗、营养支持、容量控制可减少术后并发症发生率;3~6个月病程组外科手术操作性差,外科医生手术满意度最差,心包组织残留率高,在病情稳定的情况下可酌情推后手术时间;心包剥脱范围应广泛,尽量做到不残留再狭窄的组织基础,外科医生的技术和策略对患者围术期生存率及远期效果有很大影响。Objectives To summarize the experience and effecacy of surgical treatment in patients with constrictive pericarditis,so as to provide basis for the timing of operation and theraphy in patients with constrictive pericarditis.Methods Totally 127 patients underwent pericardi ectomy from March 2015 to March 2019 in The Third People’s Hospital of Chengdu were retrospectively analyzed.According to the course from onset to operation,the patients were divided into 5 groups:within 3 months group,3-6 months group,6-12 months group,1-3 years group and more than 3 years group.The proportion of patients,symptoms,signs,operation time,prognosis and incidence of complications after operation,and the satisfaction of doctors after operation were counted to evaluate the surgical effect of constrictive pericarditis.Results All the 127 cases were successfully operated with perioperative death in 3 cases(2.36%).As the course of disease prolonged,the positive and severity of symptoms and signs increased before operation;postoperative pulmonary complications and low cardiac output syndrome increased significantly.Low cardiac output syndrome increased and hospital stay was prolonged significantly in more than 3 years group.The operability was poor,the pericardial tissue remained more and the satisfaction of doctors came in last in the survey in 3-6 months group.Conclusions Median sternotomy is the best choice for pericardiectomy.Before operation,with cardiotonic mixture,nutritional support and volume control can reduce the incidence of postoperative complications.The operability is poor,the pericardial tissue remains more and the satisfaction of doctors came in last in the survey in 3-6 months group.When the condition is stable,the operation time can be postponed as appropriate.The range of pericardial exfoliation should be extensive.The technique and strategy of surgeons have great influence on the survival rate and long-term effect of patients.

关 键 词：缩窄性心包炎 心包剥脱术 回顾性分析 

分 类 号：R542.11[医药卫生—心血管疾病]