689例心包积液病因及误诊分析

目的：分析心包积液病因变化及误诊原因。方法：病例回顾分析。结果：结核性、非特异性、肿瘤性、心力衰竭性及尿毒症性心包积液分别占６８９例心包积液的２５．５％、１２．６％、１２．２％、６．５％和６．１％，其他各种原因所致者合计占３７．１％。结核性心包积液由８０年代中期以前的２９．０％降至８０年代中期以后的２２．３％（Ｐ＜０．０５），而肿瘤性心包积液则由９．９％升至１４．１％（Ｐ＜０．０５）。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则明显上升。心包积液病因误诊主要是将肿瘤性心包积液误诊为其他性质心包积液     

心包积液101例病因分析

心包积液病因分析已有众多报道 ,但结果不尽相同。作者对本所 1996～ 1999年收治的 10 1例心包积液患者做病因分析。1　临床资料　全组 10 1(男 5 0 ,女 5 1)例 ,年龄 1～ 78(平均33.8)岁。其中 30例大量积液行心包穿刺术 ,占 2 9.7%。有 3例未行心包积液实验室检查。病因诊断是根据病史、症状、体征、心电图、超声心动图、胸片、血液、心包积液的实验室检查综合判定。2　结果　心包积液常见病因前 4位依次为 :心力衰竭 2 8例(占 2 7.7% ) ,心包切开综合征 2 1例 (占 2 0 .8% ) ,肿瘤 14例(占 13.9% ) ,风湿热 14例 (占 13.9% ) ,其中肺癌为…     

心包积液41例病因分析

心包积液４１例病因分析浙江省衢县人民医院吴国富随着起声心动图的广泛使用，心包积液发病率明显增加。我们对１９９１～１９９３年收治的４１例心包积液患者之病因和心衰所致心包积液误漏诊的原因进行分析，现报道如下。临床资料男性２３例，女性１８例，年龄２８～７６...     

60例心包积液行纤维心包镜检查的病因探讨

对６０例心包积液患者均经纤维心包镜检查，结合心包积液检验及心包病理活检的结果，癌性心包积液占首位，在非癌性积液中以非特异性心包炎占首位。作者认为，为提高心包积液病因诊断水平，建议开展心包镜检查。     

大量心包积液病因影响因素的回顾性分析

目的 收集并分析41例大量心包积液患者病因的影响因素，为诊治大量心包积液提供更为清晰诊疗思路。方法 根据2015年欧洲心血管病学会《心包疾病的诊断和治疗指南》诊断大量心包积液的标准，收集2017.1.1-2019.10.1期间入住福建省立医院及福建省立金山医院的大量心包积液患者41例，根据其病因诊断将所有入组对象分为4组：结核性心包积液组（TB组）、恶性肿瘤性心包积液组（MT组）、非TB感染性心包积液组（NTB组）及其他病因心包积液组（OE组）。采用SPSS统计软件分析所有入组患者心包积液患者病因的影响因素。结果 41例大量心包积液患者中男性24人，女性17人，平均年龄为60.3±14.9岁。TB组、MT组、NTB组及OE组患者分别占24.4%，24.4%，29.3%，21.9%。按照Light标准的定义，大量心包积病例中97.6%为渗出液。结核性心包积液的腺苷脱氨酶水平最高，达57.0±37.3U/L，远高于其他病因所致的心包积液（P<0.01）。腺苷脱氨酶诊断结核性心包积液的ROC曲线下面积0.961，最佳诊断切点为20.5U/L，此时敏感性达100%，特异性达80.6%。多元Logistics回归分析显示大量心包积液病因的主要影响因素有血红蛋白、心包积液腺苷脱氨酶水平和心包积液癌胚抗原水平。结论 本研究发现大量心包积液最常见病因是结核和恶性肿瘤，腺苷脱氨酶是诊断结核性心包积液的敏感指标，Light标准无法鉴别大量心包积液的病因，血红蛋白、心包积液腺苷脱氨酶和心包积液癌胚抗原是影响大量心包积液病因判定的重要指标，具有一定临床指导意义。     

心包积液住院患者的病因分析(附384例报告)

目的:分析近20年间384例心包积液患者的病因,探究其变化规律。方法:对我院1988～2007年收治的384例心包积液患者的临床资料进行回顾性分析。通过分析其病因构成,并按时间将其分组,了解病因构成是否发生改变。结果:肿瘤性、结核性、心力衰竭性和非特异性占心包积液病因的前4位,分别占24.5%、21.3%、14.6%、8.9%,其中结核性心包积液比例由10年前的26.8%降为18.2%(P<0.05),而肿瘤性心包积液则由10年前18.3%升为28.1%(P<0.05)。结论:不同时期病因构成不同,肿瘤已成为当前心包积液的首要病因。     

115例心包积液患者病因及误诊分析

目的分析115例心包积液患者的病因变化及误诊原因。方法收集我院1995～2004年收治的115例心包积液患者的临床资料并进行回顾性分析。结果心包积液常见病因依次为肿瘤性(19.1%)、结核性(18.3%)、非特异性(13.9%)、心力衰竭性(12.2%)、尿毒症性(6.1%)和结缔组织疾病(5.2%),其他各种原因引起者占14.8%,肿瘤已成为心包积液的首要病因。误诊8例。结论肿瘤是心包积液的首要病因。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。     

72例心包积液病因及误诊分析

目的 分析72例心包积液病因及误诊原因。方法 回顾分析2000年1月-2006年3月诊断有心包积液的病例72例。结果 心包积液病因依次是肿瘤性（22．2％）；结核性（16．7％）；心力衰竭性（12．5％）；非特异性（11．1％）；甲状腺机能减退性（8．3％）；其他病因及诊断不明的占29．2％。结论 肿瘤性心包积液发病率最高，且肿瘤性心包积液误诊为结核性及非特异性最高。     

中心静脉导管引流治疗恶性心包积液的护理

心包疾病是一种常见疾病。据尸检统计发病率约为5%,Hiroki[1]及韩立宪等[2]经纤维心包镜检查统计,恶性心包积液约占心包积液病因的47.1%,且心包积液生长迅速,积液量多,患者常出现心包填塞的症状,有效的控制积液对改善病人症状、提高病人的生活质量尤为重要。我院自2002-01～200     

心包积液的超声心动图观测及其临床价值评价(附167例报告)

心包积液占所有心脏病的2%[1],因其病因复杂又多为继发性,易被原发病所掩盖,造成漏诊或误诊。2001-2006年,煤炭总医院功能科应用彩色多普勒超声心动图,观测心包积液患者167例,现报道如下。1资料与方法     

102例心包积液患者临床病因分析

目的回顾性总结分析心包积液患者的病因分布特点及临床类型,探究其变化规律,提高病因诊断。方法对我院2001年01月至2008年12月因心包积液住院的102名患者的临床资料进行分析。结果心包积液常见病因依次为肿瘤（25．5％）,结核（22．6％）,心力衰竭（19．4％）,非特异性（13．8％）,尿毒症（9．9％）和结缔组织疾病（6．3％）,其他原因引起者占（2．5％）。结论引起心包积液的首要病因为肿瘤,其次为结核;随着诊疗水平的提高,心包积液的病因分布更趋广泛。原因不明的心包积液在排除恶性肿瘤、甲状腺功能减退等常见病因的前提下,试验性抗结核治疗有助于明确诊断。     

Acute renal failure as the presenting symptom of pericardial effusion

Pericardial effusion from any cause may lead to decreased cardiac output and blood pressure, causing heart failure and reduced renal blood flow. Although pericardial effusion is not uncommon, it is usually not associated with hemodynamic compromise unless the effusion causes cardiac tamponade. Acute renal failure resulting from pericardial effusion is surprisingly rare, with only six cases described to date. We describe the first case known to us of pericardial effusion without tamponade causing acute anuric renal failure. The case was characterized initially by non-specific symptoms and signs; anuria dominated the clinical picture, and was completely reversed after pericardiocentesis.     

Pericardial effusion diagnosed by echocardiography. Clinical and electrocardiographic findings in 171 patients

Clinical and electrocardiographic findings in 171 patients with pericardial effusion diagnosed by echocardiographic studies were reviewed. In 70 patients the effusion was unsuspected. There were 87 small, 50 moderate, and 31 large effusions. Cardiac tamponade was present in three patients. Congestive heart failure was the most common cause of pericardial effusion and occurred in 37 patients. Other frequently noted conditions included cardiac disease without congestive heart failure, neoplasms, acute nonspecific pericarditis, renal failure, and acute myocardial infarction. A pericardial friction rub was present in 23 patients, two-thirds of whom had moderate or large effusions. Atrial arrhythmias were common. Low voltage occurred in 31 of 136 patients and was more common with large effusions. The ability to distinguish between a small effusion and the quantity of pericardial fluid present normally is a problem requiring further clarification.     

老年心包积液患者病因的调查分析

目的了解老年心包积液患者随年龄增大其病因构成的变化情况。方法450例确诊为心包积液的住院患者按年龄分为非老年(0~59岁)组,老年(60~79岁)组和高龄老年(80岁以上)组,建立心包积液住院患者临床资料数据库,对比分析各组的病因构成。结果随着年龄的增大,心包积液病因构成也发生着变化。所有患者前6位的基础病因为肿瘤(22.22%)、结核(19.11%)、心力衰竭(16.44%)、肾功能不全(8.22%)、非特异性心包炎(8%)和心脏术后并发症(7.78%),老年组是肿瘤(23.5%)、心力衰竭(19.13%)、结核(14.75%)、非特异性心包炎(11.48%)、肺部感染(8.74%)和肾功能不全(6.01%),高龄老年组心包积液病因构成相对集中,前4位的病因是心力衰竭(34.62%)、肺部感染(19.23%)、肿瘤(15.38%)、肾功能衰竭(15.38%)。结论心包积液的病因随患者年龄老化,肿瘤、心力衰竭、肺部感染比例呈逐步上升趋势,结核则呈下降走势。在高龄老人,心肺功能异常导致心包积液已经接近一半。     

Pericardial effusion and tamponade

Pericardial effusion may occur as a result of a variety of clinical conditions, including viral, bacterial, or fungal infections and inflammatory, postinflammatory, autoreactive, and neoplastic processes. More common causes of pericardial effusion and tamponade include malignancy, renal failure, viral and bacterial infectious processes, radiation, aortic dissection, and hypothyroidism. It can also occur after trauma or acute myocardial infarction (as in postpericardiotomy syndrome following cardiac or thoracic surgery) or as an idiopathic pericardial effusion. Although pericardial effusion is common in patients with connective tissue disease, cardiac tamponade is rare. Among medical patients, malignant disease is the most common cause of pericardial effusion with tamponade. Table 1 shows the causes of pericardial tamponade. The effusion fluid may be serous, suppurative, hemorrhagic, or serosanguineous. The pericardial fluid can be a transudate (typically occurring in patients with congestive heart failure) or an exudate. The latter type, which contains a high concentration of proteins and fibrin, can occur with any type of pericarditis, severe infections, or malignancy. Once the diagnosis of pericardial effusion has been made, it is important to determine whether the effusion is creating significant hemodynamic compromise. Asymptomatic patients without hemodynamic compromise, even with large pericardial effusions, do not need to be treated with pericardiocentesis unless there is a need for fluid analysis for diagnostic purposes (eg, in acute bacterial pericarditis, tuberculosis, and neoplasias). The diagnosis of pericardial effusion/tamponade relies on a strong clinical suspicion and is confirmed by echocardiography or other pericardial imaging modalities. Alternatively, when the diagnosis of cardiac tamponade is made, there is a need for emergency drainage of pericardial fluid by pericardiocentesis or surgery to relieve the hemodynamic compromise. Following pericardiocentesis, it is necessary to prevent recurrence of tamponade. Intrapericardial injection of sclerosing agents, surgical pericardiotomy, and percutaneous balloon pericardial window creation are techniques used to prevent reaccumulation of pericardial fluid and recurrence of cardiac tamponade.     

Pericardial effusion and tamponade due to Kaposi's sarcoma in acquired immunodeficiency syndrome

We describe a 29-year-old homosexual man with acquired immunodeficiency syndrome who developed pericardial effusion and tamponade. Pericardiocentesis resulted in clinical improvement. All diagnostic tests on pericardial fluid were negative. At autopsy, extensive plaques and nodules of Kaposi's sarcoma were found studding the epicardium, and no other cause of effusion was found. To our knowledge there has been no previous case of Kaposi's sarcoma associated with pericardial effusion and tamponade reported in patients with AIDS. Kaposi's sarcoma should be considered in the differential diagnosis of pericardial effusion in these patients.     

Pericardial and pleural effusions in decompensated chronic heart failure

BACKGROUND: In decompensated chronic heart failure, there is controversy regarding the incidence and amount of pericardial fluid. Moreover, the relation of pericardial effusion to pleural effusion has not yet been clarified. The current study examined the incidence and amount of pericardial effusion in patients with decompensated chronic heart failure as a function of the volume of pleural effusion. METHODS AND RESULTS: The study subjects were 60 consecutive patients with chronic heart failure requiring diuresis to improve the symptoms and signs of congestion. Pericardial effusion was semiquantified on the basis of M-mode echocardiographic findings and the volume of thoracic effusion drawn from computed tomographic images of the chest with Simpson's method. Causes of decompensated chronic heart failure in the 60 patients included cardiac valve disease (n = 26), arterial hypertension (n = 12), chronic ischemic heart disease (n = 9), and others (n = 13). As many as 52 (87%) of the 60 patients had pleural effusion; of these, 45 had bilateral effusion, 5 had right-sided effusion only, and 2 had left-sided effusion only. In contrast, only 12 (20%) patients had small (n = 9) or moderate (n = 3) pericardial effusion. There was no significant association between the amount of pleural effusion and the semiquantified pericardial effusion (chi-square 3.27, P =.775). CONCLUSIONS: In this series of patients with congestive heart failure, small pericardial effusion was sometimes observed, but moderate to large effusion was uncommon, and there was no significant association between a given amount of pleural effusion and the volume of pericardial effusion.