缩窄性心包炎外科治疗42例临床分析

Clinical analysis of durgical treatment for constrictive pericarditis in 42 cases

目的回顾性分析42例缩窄性心包炎患者外科治疗的近期疗效,总结缩窄性心包炎的外科治疗经验。方法总结2011年6月~2018年12月外科治疗的42例缩窄性心包炎患者的临床资料,其中男31例、女11例。心功能分级:Ⅱ级5例、Ⅲ级26例、Ⅳ级11例。对比患者手术前后收缩压、舒张压、脉压差、中心静脉压和射血分数,术后6个月心功能并与术前比较。结果 42例患者成功剥离心包,围手术期死亡1例,死亡率为2.38%,其余41例临床痊愈出院。统计学发现术后舒张压较术前下降(P<0.05),术后脉压差较术前升高(P<0.05),术后中心静脉压较术前下降(P<0.05),术后LVEF较术前改善明显(P<0.05),术后收缩压较术前变化不明显(P>0.05)。结论外科手术是治疗缩窄性心包炎的有效方法,可根据中心静脉压、左心室射血分数、脉压差及心功能来评价手术疗效及预后效果。

Objective To retrospectively analyze the short-term efficacy of surgical treatment of 42 patients with constrictive pericarditis and to summarize the surgical treatment experience of constrictive pericarditis. Methods The clinical data of 42 patients with constrictive pericarditis who underwent surgical treatment from June 2011 to December 2018 were summarized, including 31 males and 11 females. Cardiac function classification: 5 cases of grade Ⅱ, 26 cases of grade Ⅲ, and 11 cases of grade Ⅳ. The systolic blood pressure, diastolic blood pressure, pulse pressure differ ence, central venous pressure and ejection fraction were compared before and after surgery. The cardiac function at 6 months after operation was compared with that before operation. Results The pericardium of 42 patients was successfully separated. One patient died during perioperative period, with the mortality rate of 2.38%, and the remaining 41 patients were cured and discharged. Statistical analysis showed that postoperative diastolic blood pressure decreased compared with that before operation(P<0.05), and postoperative pulse pressure difference was higher than that before operation(P<0.05). It also showed that postoperative central venous pressure decreased compared with that before operation(P<0.05), and the LVEF was significantly improved compared with that before operation(P<0.05). There was no significant difference in systolic pressure before and after surgery(P>0.05). Conclusion Surgery is an effective method for the treatment of constrictive pericarditis. The curative effect and prognosis can be evaluated according to central venous pressure, left ventricular ejection fraction, pulse pressure difference and cardiac function.