心源性胸腔积液32例诊治分析

Diagnosis and Treatment of 32 Patients with Cardiogenic Pleural Effusion

目的探讨心源性胸腔积液的临床特点及误诊原因,以提高诊断率。方法对我院2001年3月～2010年3月收治的32例心源性胸腔积液临床资料进行回顾性分析。结果本组占我院同期收治胸腔积液的23.7%(32/135),双侧胸腔积液19例,右侧11例、左侧2例。32例首诊时6例误诊,误诊率18.8%,分别被误诊为结核性胸腔积液和恶性胸腔积液。全组根据病史、体征、医技检查结果确诊为高血压性心脏病9例、扩张型心脏病6例、冠心病6例、风湿性心脏病3例和肺源性心脏病2例。结论心功能不全可导致胸腔积液,极易掩盖对肺部病变及心脏形态的观察,对于无感染中毒症状、抗结核治疗无效的胸腔积液应考虑心源性胸腔积液可能。

Objective To investigate the clinical characteristics and misdiagnosis cause of cardiogenic pleural effusion,in order to improve diagnosis rate.Methods Clinical data of 32 patients with cardiogenic pleural effusion hospitalized during Mar.2001 and Mar.2010 were collected and retrospectively analyzed.Results The 32 patients with cardiogenic pleural effusion took up 23.7%（32/135） of the pleural effusion patients admitted to our hospital during the same period,in which 19 patients were with bilateral pleural effusion,with 11 patients in the right,and 2 patients in the left.6 patients were once misdiagnosed as having tuberculous pleural effusion and malignant pleural effusion respectively,and misdiagnosis rate were 18.8%.According to medical history,signs and examination results of the group,9 patients were confirmed as having hypertensive cardiopathy,8 patients having extension heart disease,6 patients having coronary heart disease,5 patients having cor pulmonale and 4 patients having rheumatic heart disease.Conclusion Cardiac dysfunction may lead to pleural effusion,which may cover up observation of pathological changes of the lungs and heart modality.For those pleural effusion with no infected toxic symptom or anti-TB treatment,the possibility of cardiogenic pleural effusion should be taken into consideration.