超声引导经剑突下心包腔置管治疗顽固性结核性心包积液

目的 探讨超声引导经剑突下全程实时心包腔置管治疗顽固性结核性心包积液的临床疗效.方法 51例顽固性结核性心包积液患者,以ALP[丁胺卡那霉素(A)、左旋氧氟沙星(L)及对氨基水杨酸钠(P)]为基础化疗方案,加用1～2种未曾应用过的抗结核药物进行全身抗结核治疗,超声引导经剑突下心包腔置管,定期抽液及注药(异烟肼、利福平及地塞米松)治疗,平均治疗3个月.结果 51例患者心包穿刺均获成功,未出现并发症,引流导管留置时间21～60 d,平均(32±3)d,引流液量1700～3800 ml,平均(2400±55)ml.所有患者原有的不适症状消失,心包积液完全吸收,未发生缩窄性心包炎.结论 超声引导经剑突下心包腔置管治疗顽固性结核性心包积液安全,可避免损伤心肌,留置导管可持续引流,使引流彻底,便于灌洗及注药,疗效可靠.

Treating refractory tuberculous hydropertcardium by ultrasonography guided drainage tube beneath xiphoid

Objective To evaluate the effectiveness of real time ultrasound guided drainage tube placing under xiphoid. Methods Fifty-one eases of hydropericardium were refractory to traditional therapy.They were used the systemic chemotherapy regime composed of amikacin, levofloxaein aminosalicylate beside other one or two anti-tuberculosis drug never used before, placing drainage tube beneath xiphoid for periodic draining and infusing regime of isoniazide rifampine and dexamthasone. The average course was 3 months.Results All the 51 cases underwent a successful pericardium puncture without any complications. The rainage tubes were placed for 21 to 60 days with mean of (32 ± 3) days; drainage volume range from 1700 to 3800 ml,mean was (2400 ± 55)ml. All the patient showed clinical improvement, complete absorption of hydroperieardium, no constrictive periearditis occurred. Conclusions Ultrasound guided pericardium puncture and drainage tube placing is safe without hurting myoeardium. Indwelled tube this way facilitate sustained eomplete drainage lavage and drug infusing, and its effectiveness is reproducible.