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目的探讨儿童缩窄性心包炎(CP)临床特点及诊治方法。方法对1980-01—2003-12在重庆医科大学附属儿童医院住院,并经手术确诊的39例CP患儿的临床资料进行回顾性分析。结果主要症状为乏力36例(92·3%)、水肿35例(89·7%)、气促32例(82·0%),主要体征为肝脏肿大35例(89·7%)、颈静脉怒张31例(79·5%)、心音低钝或遥远31例(79·5%)。X线检查阳性率61·5%(24/39),超声心动图检查阳性率76·3%(29/38)。病因确诊为肺吸虫7例、结核5例、化脓性3例,24例病因不清。结论CP临床表现及血流动力学变化与限制性心肌病类似,其鉴别诊断比较困难,目前超声心动图在CP的诊断中仍被认为是最有价值的检查方法。一旦确诊,早期行心包切除术。

Clinical analysis of 39 children with constrictive pericarditis

Objective To study the clinical characteristics of children with constrictive pericarditis(CP).Methods The diagnosis and treatment effect of 39 children with CP were reviewed retrospectively.Results The clinical manifestations were diverse.The main symptoms included fatigue(92.31%),edema(89.74%) and dyspnea(82.05%).The main signs included hepatic enlargement(89.74%),neck vein distention(79.49%),and low or distant heart sounds(79.49%).The positive rate of X-ray was 61.54% and echocardiography was 76.32%.Causes of CP were paragonimus for 7,tuberculosis for 5,bacterium for 3 and idiopathic for 24.Conclusion The diagnosis of constrictive pericarditis remains a challenge because of its physical findings and hemodynamics mimic restrictive cardiomyopathy.Echocardiography is considered as the most valuable testing for the diagnosis of constrictive pericarditis up to date.It is important to take the pericardial resection as early as possible after CP diagnosis.