92例缩窄性心包炎误诊分析

Analysis of the Mis-diagnostic Causes of Constrictive Pericarditis in 92 Cases

目的:探讨缩窄性心包炎的误诊原因。方法:回顾性总结我院2000-01至2008-01年连续诊断的150例缩窄性心包炎患者的门诊与住院资料。结果:在150例患者中,92例在病程中曾发生误诊,误诊率61.3%。92例心包缩窄的病因分别为:结核81.5%(75/92),其他疾病15.2%(14/92),不明原因3.3%(3/92)。误诊为其他心血管疾病及其他各种疾病51例,诊断为结核性心包炎、胸膜炎等进行抗结核治疗但未识别出心包缩窄的22例,长期诊断不明17例,2例非结核误诊为结核。隐匿起病者误诊率高,无心包积液病史的患者误诊率高,不典型结核误诊率高,合并全身多处结核的易漏诊心包缩窄。结论:缩窄性心包炎误诊率仍较高,临床医生提高对缩窄性心包炎的警惕以及心脏超声医生提高对缩窄性心包炎的认识可减少误诊,上腔系统静脉压升高的表现是缩窄性心包炎的重要体征,临床医生应充分重视体格检查。

Objective ：To retrospectively analyze the misdiagnostic causes of constrictive pericarditis. Methods ： One hundred and fifty consecutive constrictive pericarditis patients proven by pathological examination in our hospital between January 2000 and January 2008 were analyzed. Results ：92 of 150 （61.3%） patients had been misdiagnosed. Among those patients,81.5% （75/92） were caused by tuberculosis, 15.2% （ 14/92 ） by other diseases, 3.3% （3/92） with unknown reasons. The misdiagnostic causes including different cardiovascular diseases, chest problems and unknown reasons. The misdiagnostic rate was high in patients without pericardial effusion history and lack of typical tuberculosis manifestations. Conclusion：The misdiagnostic rate of constrictive pericarditis was high, echocardiographic findings and increased pressure of superior vena cava system should be emphasized to avoid misdiagnosis.