383例心包积液病因分析

总结了３８３例心包积液的病因分布特点，发现病因的构成随着年代的变迁而有所变化。前三位病因依次为结核，心力衰竭，恶性肿瘤。心包积液的发病率逐年增高，其中，一心包积液的增多尤其明显。根据二维超声心动衅检查的结果，心衰性心包积液９０％为少量积液，而结核，肿瘤性心包积液７０％以上为中－大量积液，且结核，肿瘤心包积液中血性积液患者分别占８５％，９３％，经统计学处理，Ｐ〈０．０５。     

78例心包积液临床病因分析

心包积液的病因复杂 ,了解心包积液的病因组成 ,有助于正确诊断和针对性治疗。近年来 ,发病多少的顺序与国内过去的报道有所不同。现对我院 78例心包积液的病因进行分析。1　临床资料1 994～ 1 998年间我院收治心包积液 78例。男 5 0例 ,女 2 8例 ;年龄 2～ 89岁 ,平均 48岁。病因诊断主要根据临床症状、体征、心电图、超声心动图、胸片、胸部 CT和磁共振以及血液、心包穿刺抽液的实验室检查。在超声心动图上根据液性暗区的位置及其宽度确定积液量。心包穿刺抽液 34例 ,手术取心包活检4例 ,结果 (见表 1 )。表 1　 78例心包积液的病因分布…     

心包积液85例病因分析

心包积液病因复杂多样 ,早期诊断较为困难 ,临床误诊率较高 ,因其病因与治疗及预后密切相关 ,故对我院收治的 85例心包积液病因进行分析 ,有助于正确诊断和治疗。1　临床资料1 1　心包积液患者共 85例 ,男性 5 0例 ,女性 35例 ;年龄 2 7～ 6 8岁 ,结核性 45例 (5 3%) ,心力衰竭性 15例(18%) ,恶性肿瘤性 12例 (14%) ,尿毒症性 7例 (8 2 %) ,非特异性 5例(5 9%) ,ＳＬＥ1例 (1 8%)。1 2　 85例均经超声心动图检查证实为心包积液 ,病因诊断主要依据临床症状 ,体征、心电图、超声心动图、胸片、胸部ＣＴ、血沉、心包穿刺液的常规检查和脱落细…     

心包积液39例病因分析

目的 提高对心包积液病因的再认识.方法 对我院收住39例心包积液患者的病因作回顾性分析.结果 常见的病因为心力衰竭性(14例)、结核性(9例)、癌性(6例),少见的病因为类风湿性、甲状腺功能减退性、病毒性心包炎性(各2例),嗜酸粒细胞性、系统性红斑狼疮性、尿毒症性、流行性出血热性心包积液(各1例),初诊全部误诊,死亡9例.结论 提高对常见的及少见心包积液病因的认识,有助于及时诊断并针对病因治疗,从而降低病死率.     

38例大量血性心包积液的病因分析

血性心包积液由多种病因引起。临床上往往因病因难以确定而影响病人的治疗。为此，我们总结了1983～1997年38例大量血性心包积液患者的临床表现及疗效情况，旨在给本病的病因诊断提供一些资料。1资料和方法1．1病例选择：38例均为我科住院病人．其中男26例，女12例，年龄14～77岁．平均41．5岁，均心包积液原因待查人院。根据超声检查标准，38例均属大量心包积液。心包穿刺，2例心包液呈淡红色，36例呈静脉血样红色。1．2方法：除一般常规检查外，结核菌菌皮肤试验（PPD），间接免疫荧光法检查血抗核抗体（ANA），皮肤狼疮带试验，肾穿病…     

200例心包积液病因分析

自1985年11月至1998年6月，经超声检查等检出心包积液200例，现对其病因进行分析讨论。     

80例心包积液患者临床病因及误诊分析

目的:分析心包积液患者的病因及误诊原因。方法:收集彭州市人民医院和成都市第五人民医院1997~2006年心包积液患者80例,对其临床资料进行回顾分析。结果:心包积液的常见原因依次为肿瘤性(25·0%)、结核性(18·8%)、非特异性(13·7%)、心力衰竭性(12·5%)、尿毒症性(10·0%),其他原因(20·0%)。其中有6例误诊。结论:结核性心包积液比例明显下降,而肿瘤性心包积液所占比例明显上升,已成为心包积液的首要原因。误诊的主要原因是将肿瘤性心包积液诊断为其他性质的心包积液。     

心包积液67例临床表现的多样性及病因分析

目的回顾以心包积液为主要临床表现而就诊的病例,分析其病因及治疗预后。方法总结近20年来以心包积液为主要临床表现而就诊的患者共67例。结果病因构成：肿瘤性心包积液30例,占首位,其他依次是结核性心包积液16例,心力衰竭致心包积液（心包积水）8例．非特异性心包积液6例,甲状腺机能减退症心包积液4例,系统性红斑狼疮心包积液3例。病情预后与病因明显相关,但诊疗不及时可使病情恶化。结论肿瘤性心包积液在以心包积液为首诊的患者中的比例有明显升高趋势,目前为首要发病因素,且无明显年龄分布特点,对反复发作的心包积液需积极随访检查除外恶性肿瘤。     

心包积液的病因及误诊分析

目的分析心包积液患者的病因及误诊原因。方法收集2007～2011年收治的65例心包积液患者的临床资料并进行回顾性分析。结果本组资料心包积液常见病因依次为肿瘤性(33.85%)、结核性(23.08%)、心力衰竭性(10.77%)、非特异性(7.69%)和结缔组织疾病(6.15%),其他各种原因引起者占18.48%。误诊4例。结论肿瘤是心包积液的首要病因。误诊的主要原因是将其他性质的心包积液误诊为肿瘤性心包积液。     

恶性心包积液40例临床分析

目的：探讨恶性心包积液的临床特征和诊断要点。方法：对临床资料完整的恶性心包积液４０例病人,分析其临床表现,超声心动图特征、心电图及Ｘ线胸片结果,结合病理学及（或）细胞学检查,进行讨论。结果：４０例恶性心包积液,７例为原发性心包间皮瘤,其余３３例为心包转移癌。约６３％心包液为血性,３７％为淡黄色。心包液量为少量、中等量或大量。心电图检查及Ｘ线胸片对诊断心包积液的性质无特异性。超声心动图可有以下特征性表现：心包广泛增厚,心包内显示点位,心肌肿瘤浸润,心脏受压表现,心腔内肿物。病人均有原发癌肿的细胞学及（或）病理学证据,或心包液中查到癌细胞。结论：原发癌肿的病理学检查或心包内查到癌细胞是确诊的重要依据,二维超声多切面探查对确定心包内肿物有重要价值。     

癌性心包积液的超声心动图表现

本文报道4例经病理证实为癌性心包积液所致的“心脏摇摆综合征”的超声心动图表现,并对此现象产生的机理进行了讨论。本组病例观察表明,大量心包积液出现心脏摇摆综合征,特别是在成年人出现心脏机械性交替合并电交替的典型“心脏摇摆综合征”时,应高度怀疑癌性心包积液的可能。     

改良Seldinger介入置管法治疗顽固性大量心包积液

目的：探求治疗顽固性大量心包积液(RLPE)安全、有效、简便的置管引流方法。方法：选用美国ARROW公司生产的中心静脉置管装置，在心超引导下，对12例RLPE采用Seldinger's经皮穿刺心包留置导管，进行全封闭适度负压持续引流。结果：不仅装置简便、操作简化、定位准确，而且置管可靠、引流彻底、疗效确切，无不良反应及损伤。结论：该介入置管法是对传统置管方法的改进，是目前RLPE科学和实用的引流治疗方法。     

胸腔镜心包开窗术治疗难治性恶性心包积液的价值

目的：评价胸腔镜心包开窗术治疗难治性恶性心包积液的效果。方法：对32倒难治性恶性心包积液患者行胸腔镜心包开窗术。比较治疗前、后生活质量Karnofsky评分。结果：心包积液完全缓解率为100％,疾病进展时间10．7个月,中位生存期12．3个月。Karnofsky评分治疗前（68．8±1．7）分,治疗后（90．8±2．3）分,有显著差异（t=9．92,P〈0．01）。结论：胸腔镜心包开窗手术治疗难治性恶性心包积液能有效地提高生活质量和延长生存时间,可考虑作为难治性恶性心包积液的首选治疗方法。     

Pericardial Effusion Increases Defibrillation Energy Requirement

Pericardial effusion may increase defibrillation energy requirements. We examined the effect of pericardial effusion in seven pentobarbital anesthetized dogs (25.3 ± 3.4 kg) using monophasic and biphasic shock. A median sternotomy was performed and two 13.9 cm² patch electrodes were sewn extrapericardially; 3 cc/kg of 0.9% NaCl was instilled through an intrapericardial catheter used to create a hemodynamically insignificant pericardial effusion. Four triais of five leading edge voltages (200–600 volts, in 100 volt increments) were performed for monophasic and biphasic shocks of 10 msec total duration and defibrillation efficacy curves were determined by logistic regression anaiysis. Baseline impedance was 68.1 and 66.2 Ohms for monophasic and biphasic waveforms, respectiveiy, and decreased to 52.9 and 49.9 Ohms, respectively, with pericardial effusion (P < 0.01). Energy associated with 80% probability of successful defibrillation (E80) for monophasic shock was 16.0 jou]es at baseline and increased to 18.5 joules with pericardial effusion (P < 0.016). Similarly, E80 for biphasic shocks increased from 10.6 joules to 13.0 joules (P < 0.016). Removal of pericardial effusion was associated with impedance and E80 returning to baseline. In this model, pericardial effusion increased defibrillation energy requirements and may expiain early postimplant defibrillator failure.     

Incidence of Pericardial Effusion in Patients Presenting to the Emergency Department with Unexplained Dyspnea

OBJECTIVE: To evaluate the frequency of pericardial effusion in patients presenting to the emergency department (ED) with unexplained, new onset dyspnea. METHODS: This prospective observational study took place at an urban community hospital ED with a residency program and an annual census of 65,000 visits. Patients presenting between May 1999 and January 2000 with new-onset dyspnea were eligible if they lacked any pulmonary, infectious, hematological, traumatic, psychiatric, cardiovascular, or neuromuscular explanation for their dyspnea after ED evaluation. Patients received a focused echocardiogram by certified emergency physicians. Data were recorded on standardized data sheets and studies were taped for review. Effusions were categorized as small when the fluid stripe measured less than 10 mm. Moderate-sized effusions measured 10 to 15 mm. Large effusions measured more than 15 mm. RESULTS: One hundred three patients were enrolled. Median age was 56 years (IQR 44, 95% CI = 32 to 67). Fourteen patients (13.6%, 95% CI = 8% to 23%) had effusions. Four had large effusions that explained their dyspnea and were admitted to cardiology; two of these effusions were hemorrhagic, and two were viral in origin. Seven patients with small effusions were treated conservatively at home. Three patients had moderate-sized effusions; all were admitted but treated conservatively. CONCLUSIONS: While limited by small numbers, these preliminary data suggest that patients with unexplained dyspnea should be checked for pericardial effusion when bedside ED ultrasound is available.     

心包积液的超声显像研究

目的研究超声心动图对心包积液的应用价值。 方法回顾性分析413例心包积液的超声心动图特征，并与X线、心电图及手术结果相对比。 结果心包积液病因依次排列前5位的是恶性肿瘤、心力衰竭、尿毒症、结核、炎症。超声心动图诊断率100％，X线诊断62例，占15％；心电图诊断12例，占3％。21例外科手术治疗。 结论超声心动图是诊断心包积液最简单、最可靠的方法，也是一种介入心包穿刺，术中动态监测，判断预后的方法。     

An Unusual Cause of Dysphagia: Pericardial Effusion after Implantable Cardioverter-Defibrillator Placement

Background

Dysphagia is a known complication of pericardial effusions. Most cases of pericardial effusions are idiopathic, infectious, and neoplastic, but can also occur after cardiac procedures.

Objective

To report the case of a patient who developed dysphagia from a sub-acute pericardial effusion caused by the placement of an implantable cardioverter-defibrillator (ICD).

Case Report

A 62-year-old woman presented to the Emergency Department (ED) with a 2-day history of dysphagia. Imaging revealed a large pericardial effusion compressing the esophagus from the mid-thoracic level to the gastroesophageal junction. Ten days prior, a dual-chamber ICD with small-diameter active fixation leads was placed in the patient. There had been no apparent complications from the procedure, however, over this 10-day period she developed a sub-acute pericardial effusion from an incidental perforation during ICD lead placement that led to the extrinsic compression of the esophagus and her presenting symptom of dysphagia. The patient underwent pericardiocentesis for the pericardial effusion and she was discharged in stable condition.

Conclusion

This case report highlights the importance of recognizing a non-cardiac complaint such as dysphagia as the primary symptom of a critical cardiac condition. With an increase in cardiac procedures anticipated, clinicians should consider the possibility of a pericardial effusion as a cause of dysphagia, especially for those patients with recent cardiac procedures.