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目的研究心包腔内尿激酶灌洗结合心包引流能否预防感染渗出性心包炎患者心包缩窄的发生。方法 1995年至2010年收治的36例感染渗出性心包炎患者(其中化脓性心包炎1例,结核性心包炎35例,病程少于1个月),其中男性27例,女性9例,年龄(47.5±7.5)岁。按入选次序随机进入治疗组20例(常规治疗的基础上经皮导管心包内尿激酶灌洗)或对照组16例(仅接受常规治疗,包括心包引流)。心包内纤维蛋白溶解治疗(纤溶治疗)的近期效应通过心脏超声观察,远期效应通过电话询问及心脏超声随访,随访截止日期为2010年1月,随访期限为1～12(6.0±3.2)个月。结果经皮心包内尿激酶灌洗治疗有利于心包积液彻底引流,明显减小心包厚度:治疗后较治疗前心包壁层厚度明显变薄〔(1.5±0.8)mmvs(3.0±1.5)mm,P<0.01〕,对照组心包壁层厚度变化不明显〔(3.0±1.5)mmvs(3.5±1.6)mm,P>0.05〕。且尿激酶灌洗治疗可同时消除心包局部的早期粘连,未见出血及其他穿刺部位相关并发症。随访期内无1例发生死亡,治疗组及对照组分别有1例(5.00%)及3例(18.75%)发生心包缩窄。Cox模型生存分析提示,心包内尿激酶纤溶治疗后可明显降低心包缩窄的发生率。结论经皮导管心包内尿激酶纤溶治疗安全,可有效地预防心包炎患者心包缩窄的发生。
Objective To study whether pericardial urokinase lavage combined with pericardial drainage can prevent pericardial constriction in patients with exudative pericarditis. Methods Thirty-six patients with exudative periostitis (1 suppurative pericarditis and 35 tuberculous pericarditis) were enrolled in this study from 1995 to 2010. There were 27 males and 9 females, Age (47.5 ± 7.5) years. Randomly into the treatment group according to the selected sequence of 20 patients (routine treatment based on percutaneous catheter peritoneal urokinase lavage) or control group of 16 patients (only accepted routine treatment, including pericardial drainage). Recent effects of pericardial fibrinolytic therapy (fibrinolytic therapy) were assessed by echocardiography. Long-term effects were assessed by telephone and echocardiographic follow-up. The follow-up was January 2010 with a follow-up of 1-12 (6.0 ± 3.2) Months. Results Percutaneous pericardial lavage of urokinase was effective in draining the pericardial effusion and significantly reducing the pericardial thickness. The pericardial wall thickness was significantly thinner than that before treatment [(1.5 ± 0.8) mm vs (3.0 ± 1.5) mm, P <0.01). The thickness of the pericardial wall in the control group was not significantly different from that in the control group [(3.0 ± 1.5) mm vs (3.5 ± 1.6) mm, P> 0.05). And urokinase lavage treatment can simultaneously eliminate early pericardial adhesions, no bleeding and other puncture site related complications. None of the patients died during the follow-up period. One patient (5.00%) and three patients (18.75%) in the treatment group and control group respectively had pericardial constriction. Survival analysis of Cox model suggested that pericardial fibrinolytic therapy could significantly reduce the incidence of pericardial constriction. Conclusion percutaneous catheter peritoneal urokinase fibrinolysis safe, can effectively prevent pericarditis patients with pericardial constriction.