28例结核性缩窄性心包炎临床诊疗分析

Clinical analysis of 28 cases with constrictive tuberculous pericarditis

目的通过分析结核性缩窄性心包炎(CTP)的临床特点、治疗与转归,以期提高CTP的诊疗水平。方法对手术后病理证实为CTP的28例病人临床资料进行分析与总结。结果CTP主要症状为气促、心悸、胸闷及腹胀,体征主要为颈静脉怒张与下肢水肿;多合并心包外结核病;心脏超声及CT检查均示心包膜增厚伴有钙化;手术后症状及心功能均有缓解而全部出院,术后随访4～24个月无需二次手术。结论CTP临床症状无特异性,心包外结核病是CTP初步诊断依据;心脏超声和胸部CT是判断结核性心包炎是否已发生缩窄的可靠指标;手术是解除CTP心脏机械性压迫有效而又比较安全的治疗手段;加强围手术期的治疗是降低手术风险的关键。

Objective To improve the diagnosis and treatment of constrictive tuberculous pericarditis （CTP）. Method Clinical data of 28 cases which were proved to be CTP after operation were analyzed. Results The main symptoms of CTP were pant, palpitation and abdominal distention. And the main sign included jugular vein dilatation, legs edema. Many of these cases were complicated by tuberculosis of other organs. The results of ultrasonic examination and CT showed the thickness and calcification of pericardium. The symptoms were mitigated and cardiac capability was improved after operation. None of them needed second operation during the next four months to two years. Conclusion There is no special clinical symptom for CTP. Preliminary diagnosis depends on the tuberculosis of other organs, The results of ultrasonie examination and CT are reliable basis. For patients with CTP, the operation is effective and secure to relieve the mechanical stress of heart. Improving perioperative therapy is a critical factor in reducing the risk of operation.