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目的探讨慢性缩窄性心包炎的临床特点、诊断要点和手术方法。方法回顾性分析手术治疗的21例慢性缩窄性心包炎病例。结果慢性缩窄性心包炎的特征为:①反复气紧、颈静脉怒张、胸水、腹水及双下肢水肿而难以用心衰、肝硬化、限制性心肌病、低蛋白血症等原因来解释;②心包炎患者经心包穿刺引流、药物治疗后心包积液减少或消失,但症状、体征无缓解反而加重;③心脏超声和胸部CT均显示脏壁层心包明显增厚、粘连;④中心静脉压及肘静脉压明显升高,腔静脉扩张。结论心脏超声、胸部CT、中心静脉压(CVP)和肘静脉压测定、ECG等检查是诊断慢性缩窄性心包炎的重要手段。慢性缩窄性心包炎一经确诊,应尽早手术切除增厚心包,解除心脏的机械压迫。术前须规范抗结核治疗,强心、利尿、护肝、胸穿抽液,纠正低钠、低钾、低氯和低蛋白血症等,改善机体状况。认为采用胸骨正中切口手术野暴露良好,操作便利,可获得理想的切除范围。心包切除范围依据可借助中心静脉压监测、适可而止。
Objective To investigate the clinical features, diagnosis points and surgical methods of chronic constrictive pericarditis. Methods Retrospective analysis of surgical treatment of 21 cases of chronic constrictive pericarditis. Results The characteristics of chronic constrictive pericarditis were: (1) repeated gas tightness, jugular venous distention, pleural effusion, ascites and edema of both lower extremities and difficult to explain with heart failure, cirrhosis, restrictive cardiomyopathy, hypoproteinemia and other reasons ; Pericarditis patients by pericardiocentesis drainage, pericardial effusion after drug treatment to reduce or disappear, but the symptoms and signs without remission aggravating; ③ echocardiography and chest CT showed dirty parietal pericardium was significantly thickening, adhesions; ④ central vein Pressure and elbow venous pressure was significantly increased, vena cava dilatation. Conclusions Echocardiography, chest CT, central venous pressure (CVP) and elbow venous pressure measurement, ECG and other tests are important methods for the diagnosis of chronic constrictive pericarditis. Chronic constrictive pericarditis once diagnosed, surgical resection of the thickened pericardium should be as soon as possible to lift the heart of mechanical compression. Preoperative standard anti-TB treatment, cardiac, diuretic, liver protection, chest wear fluid, correct low sodium, low potassium, low chlorine and hypoproteinemia, to improve the body condition. That the use of surgical incision sternum exposed well, easy to operate, can be the ideal range of resection. The scope of pericardial resection can be based on the monitoring of central venous pressure, within a reasonable range.