缩窄性心包炎诊断指标及诊断流程分析

Constrictive Pericarditis Diagnostic Indicators and Diagnostic Process Analysis

目的通过对各种与缩窄性心包炎有关的临床表现及辅助检查进行多因素分析,设置合理的诊断流程,最大限度地减少缩窄性心包炎的漏诊。方法选择2006年1月—2011年10月我科临床疑似缩窄性心包炎的患者及漏诊的缩窄性心包炎患者共128例,对其症状、体征、生化检查、胸片、心电图、超声检查进行多因素分析。结果胸闷、胸痛、发热、腹胀、下肢水肿、肝脾肿大、转氨酶升高、胸腔积液、室间隔抖动、左房室瓣E峰吸气相较呼气相>25%、下腔静脉增宽且随呼吸变化率<50%、心包积液、腹腔积液对于缩窄性心包炎的诊断有统计学意义(OR>1)。根据多因素分析设计了合理的诊断流程,上腹部超声的检查有助于了解是否存在肝淤血的声像,选择较为廉价的心脏超声或者进一步实施心脏CT检查,通过心脏超声或者CT的间接表现或直接表现可做出诊断。结论医生应当熟悉缩窄性心包炎相关的各种特征的诊断价值,正确选择检查项目和合理设置流程,有助于减少缩窄性心包炎的漏诊。

Objective To analyze the clinical presentations and examination results of constrictive pericarditis with an attempt to optimize the diagnosis process and lower misdiagnosis rate. Methods Totally 128 patients with suspected constrictive pericarditis and/or missed diagnosis of constrictive pericarditis from January of 2006 to October of 2011 were enrolled in this stud- y. Their symptoms/signs, biochemical test resuhs, as well as findings of chest X - ray, electrocardiography, and uItrasonogra- phy were recorded and analyzed. Results Chest pain, fever, abdominal distension, lower extremity edema, hepatosplenomeg- aly, elevated transaminases, hydrothorax, ascites, inferior vena cava broadening, diameter changing rate 〈 50% with respira- tory, ventricular septal jitter, changing rate of mitral E peak in inspiratory phase than expiratory phase 〉 25%, and pericardial effusion were suggestive of constrictive pericarditis. An diagnosis of constrictive pericarditis could be directly or indirectly made based on ultrasound and/or CT findings. Conclusion General practitioners should be familiar with the values of various diagnos- tic indicators and choose the appropriate examination modalities to lower the missed diagnosis of constrictive pericarditis.