早期心包切除治疗急性化脓性心包炎21例临床观察

目的 总结急性化脓性心包炎的治疗经验。方法 回顾性分析21例急性化脓性心包炎早期施行心包切除术治疗的临床资料。结果 全组均在气管插管全麻下经左胸第四或第五肋间前外侧切口施行手术。心包切除范围两侧至膈神经前缘，左侧膈神经后方心包也尽量切除，上达主动脉和肺动脉根部，下至膈面。全组均顺利完成手术，无术中死亡，手术时间135-240min，平均155min。术后发生肺水肿2例，左肺不张1例，切ISl感染1例。术后体温恢复正常时间5-9d，平均7d。手术后住院时间11-25d，平均15d，全组均治愈出院。18例随访1．10年，无缩窄性心包炎发生。结论 早期心包切除治疗急性化脓性心包炎具有操作简单、安全可靠、并发症少、感染灶清除彻底、住院时间短及不会继发缩窄性心包炎等优点，是治疗化脓性心包炎较为理想的方法。

Pericardiectomy for acute suppurative pericarditis of early stage: a report of 21 cases

Objective To summarize the therapeutic exp er ience of acute suppurativ e pericarditis. Methods The clinical data of 21 cases of ac ute suppurative per icarditis at early stage treated with pericardiectomy were retrospectively analy zed. Results Left anterolateral incision was made in all the patients under gen eral anesthesia. The resection range was that the two sides were the anterior b o rders of phrenic nerve, the upper border was the root of aorta and pulmonary art ery, and the inferior border was diaphragmatic surface. All patients survived t h e operation. The operation time was 135 min to 240 min with the mean time of 15 5 min. After the operation, two patients developed pulmonary edema, one atelecta s is and one infection of incisional wound. It took 5 to 9 d for body temperature to return normal with an average of 7 d. The hospital stay was from 11 to 25 d ( mean 15 d). There was no patient suffered from constrictive pericarditis in 18 c ases followed up for 1 to 10 years. Conclusion Pericardiec tomy for acute supp urative pericarditis at early stage has many advantages, such as simple operatio n, safe and less complications.