结核性心包炎36例临床分析

The clinical analysis on 36 tuberculous pericarditis cases

目的通过对结核性心包炎(tuberculous pericarditis,TP)的临床特点分析提高对TP的诊断治疗水平。方法对36例TP的临床资料进行回顾性分析。结果(1)青壮年多见;(2)发热、胸痛、胸闷憋气为渗出性结核性心包炎(effusive tuberculous pericarditis,ETP)的常见临床症状;腹胀、呼吸困难为缩窄性结核性心包炎(constrictive tuberculous pericarditis CTP)常见临床症状;(3)ETP合并双侧胸腔积液多见,少数合并其他浆膜腔积液;(4)ETP心包积液以血性液占大多数,纤维素渗出多见,常规、生化、腺苷脱胺酶(adenylate deaminase,ADA)对ETP有诊断价值;(5)心动超声检查对心包积液探查敏感、可靠、易行,结合心脏CT检查对CTP有较高的诊断价值;(6)含利福平治疗方案的临床效果较为满意,手术是CTP的最有效的治疗方法。结论对于发热、胸痛、胸闷憋气青壮年患者应摄X线胸片、超声心动检查及积液常规、生化、ADA检查除外ETP;对腹胀、呼吸困难青壮年患者除进行上述检查还要结合心脏CT检查除外CTP。早期诊断并采用含RFP方案治疗,效果较好。

Objective To improve the diagnostic and therapeutic level through the analysis of the clinical characteristics of tuberculosis pericarditis（TP） .Methods Retrospective analysis on the clinical data of 36 cases of TP. Results （ 1 ） Youth and adult cases was most common. （2） Fever, chest pain and oppressed feeling were the most frequent clinical symptoms of TP. Abdominal distension and dyspnea were the most frequent clinical symptoms of constrictive tuberculosis pericarditis（CTP）. （3） most of TP were complicated with bilateral pleurisy. A few were complicated with other cavity hydrops. （4） Most of pericarditis were hemorrhagic effusion and fibrose effusion was common. ADA detection was significance for diagnosis of effusive tuberculosis pericarditis（ETP） besides pericarditis routine and biochemistry. （5） Echocardiographic（Echo） examination is a sensitive, reliabal and feasible method to detection of pericarditis. Echo combined with CT examination was a highly value in diagnosis of CTP. （6）The clinical efficacy of chemotherapy with rifampicin containing regime yielded satisfactory clinical efficacy. Surgery was the most efficient therapy. Conclusion To those febrile accompanied with chest pain and oppressed feeling youth - prime of life patients, the physician should pay attention to the investigation of chest film, Echo and pericarditis routine, biochemistry, ADA detection to rule out ETP. To those abdominal distention and dyspnea youth - prime of life patients, CT examination is necessary as well to rule out CTP. Early diagnosis and treat with RFP contriving regime may yield the satisfactory results.