缩窄性心包炎的外科治疗

Surgical Treatment of Constrictive Pericarditis

自１９８２年５月至１９９８年５月协和医院心脏外科手术治疗缩窄性心包炎患者３７例，男２６例，女１１例，平均年龄（３１．８±１６．４）岁。术前大多有水肿、呼吸困难、胸痛等症状。Ｘ线检查有２２例钙化，钙化率５９．５％。术前心功能ＮＹ－ＨＡ分级Ⅱ级（７例），Ⅲ级（２１例），Ⅳ级（９例），术前中心静脉压为（０．２２±０．０６）ｋＰａ。其中２１例行全心包切除术，１６例行部分心包切除术。３６例术后心功能均明显改善，１例术后早期死于低心排，死亡率２．７％。术后随访，２例行部分心包切除术患者分别于术后第３年和第５年死于心力衰竭。还就手术时机、手术方式。

From May 1982 to May 1998,37 patients with constrictive pericarditis, 26 males and 11 females with a mean age of 31 8±16 4 years, underwent heart surgery Pedal edema, dyspnea, fatigue, and chest pain were the most common symptoms Twenty two patients had calcification on chest roentgenograms with the calification being 59 5 % Preoperative New York Heart Association (NYHA) class was Ⅱ(7), Ⅲ(21),Ⅳ (9), and central vernous pressure (CVP) was (0 22±0 06) kPa. A total pericardiectomy was performed in 21 patients and pericardiectomy limited in 16 patients Thirty six patients (97 3 %) achieved NYHA class Ⅰ and Ⅱ postoperatively One patient (2 7 %) died in the 7th day after operation It was concluded that early pericardiectomy is recommended when pericardial constriction is diagnosed The method of operation must be determined in terms of the severity of the disease. The operative time, operative approach, operative accidents and perioperative management were introduced and discussed also