缩窄性心包炎外科治疗72例临床分析

目的探讨外科手术治疗缩窄性心包炎的经验。方法对72例缩窄性心包炎病人的外科治疗情况进行总结分析。结果72例术后1个月心功能Ⅰ级(59例)、Ⅱ级(11例)。1例术中死于急性心肌膨胀,1例术后死于低心排综合征。结论心包切除程度、手术时机、手术方法是此类手术成功的关键。     

系统性红斑狼疮心脏受累的诊治进展

系统性红斑狼疮（SLE）是最常见的系统性自身免疫性疾病之一,合并心脏受累的发生率高达50%以上,而心脏受累常常是SLE患者预后不良和死亡的主要原因。其发生机制包括：心脏和血管的自身免疫性炎症,T细胞激活释放大量细胞因子,长期使用糖皮质激素加速冠状动脉硬化等,上述因素共同作用导致心脏病变和早发的冠状动脉粥样硬化。心脏各层均可受累,心包炎最常见,约见于60%的SLE患者,心肌病变和早发冠状动脉粥样硬化也比较常见,是SLE的常见死因。因此,应常规对SLE的患者进行心脏受累的筛查,早期诊断,并尽早积极治疗可改善SLE患者的预后。     

缩窄性心包炎诊治现状及进展

缩窄性心包炎是不同原因造成的心包慢性炎症,表现为心包丧失弹性,心脏舒张受限,进而全身血液循环障碍。部分患者发病隐匿,缺乏典型临床表现。临床医师需通过详细的超声心动图、CT、核磁共振和右心导管检查来识别特征性的影像表现,外科手术剥离心包是有效治疗方法。该病误诊漏诊率高,为此本文综述了该病的诊治现状及进展。     

Cryptococcus neoformans pericarditis in a lung transplant recipient: Case report,literature review and pearls

A 68‐year‐old man presented for outpatient evaluation of dyspnea and new‐onset atrial fibrillation 9 months after undergoing bilateral lung transplantation. Echocardiography prior to cardioversion raised concern for tamponade. Therapeutic pericardiocentesis returned fluid containing 1875 wbc/mcl (68% pmn) and yielded Cryptococcus neoformans in culture. Cryptococcal antigen was detected in serum at a titer of 1:20. Cerebrospinal (CSF) fluid was without evidence of inflammation and without detectable cryptococcal antigen. There was no radiographic evidence of pulmonary cryptococcosis. Cultures of blood and CSF were without growth. Liposomal amphotericin B (3 mg/kg/day) was administered for 15 days. Oral fluconazole was added on day seven of amphotericin, and the patient was discharged to home 3 days later. Daily dosages of prednisone (10 mg), mycophenolate (500 mg), and tacrolimus (3 mg) at discharge were the same as at hospital admission. He was readmitted 12 days later with dyspnea and with re‐accumulation and loculation of pericardial fluid. A pericardial window was created. Pericardial fluid contained 722 wbc/mcl (35% pmn); Cryptococcus was not identified on direct examinations or cultures of pericardial fluid or tissue. Cryptococcus antigen was present in serum at 1:160. Liposomal amphotericin B was resumed and continued for 2 weeks followed by resumption of fluconazole. Mycophenolate was stopped. Prednisone and tacrolimus were continued. Restrictive pericarditis was evident 3 weeks after window creation. Colchicine was initiated, prednisone increased to 15 mg daily and pericardiectomy planned. We aim to raise awareness to Cryptococcus as a potential etiology for pericarditis in solid organ transplant recipients.     

缩窄性心包炎的外科治疗

目的总结缩窄性心包炎的外科治疗方法.方法回顾分析1996年7月～2004年7月我科收治的缩窄性心包炎72例的病历资料.结果本组病例全麻下行心包剥脱术72例,治愈57例(79.2%),好转10例(13.9%),死亡3例(4.1%),无效2例(2.8%).结论手术治疗缩窄性心包炎是最有效的手段,如病人确诊为该疾病应尽早手术治疗.加强围术期处理是提高本病疗效,降低死亡率的关键.