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目的:观察留置中心静脉导管引流加尿激酶心包内灌洗治疗急性结核性心包炎的疗效。方法:自1996年1月～2009年5月对我院48例临床确诊为急性结核性心包炎伴中到大量积液的患者(病程均短于1月),男28例,女20例,年龄14～72岁。随机分为两组,治疗组(常规抗结核、肾上腺糖皮质激素治疗的基础上给予留置中心静脉导管心包引流加心包内尿激酶灌洗治疗)或对照组(常规抗结核、肾上腺糖皮质激素治疗基础上给予留置中心静脉导管引流)。观察并比较两组穿刺并发症(心包内出血、心律失常及感染),治疗前、后心包膜厚度的变化,拔管时心包积液的残留量,以及通过电话问询及心脏超声随访并发症,随访截止日期为2010年5月。随访期限为11～132个月。结果:治疗组与对照组比较,治疗组治疗1周及2周后心包膜厚度的变化、拔管时积液残留量及发生心包缩窄方面有明显差异(P<0.05),穿刺相关并发症方面无明显差异(P>0.05)。全部治疗组患者给予尿激酶治疗后未见心包内出血及系统性出血并发症。随访期内无一例发生死亡,治疗组及对照组分别有1例(4.2%)及8例(33.3%)发生心包缩窄。结论:留置中心静脉导管加尿激酶灌洗治疗急性结核性心包炎安全、可行,心包积液引流彻底,拔管时间早,心包膜增厚程度显著减轻,心包粘连机会减少,能有效地预防患者心包缩窄的发生。
Objective: To observe the curative effect of indwelling central venous catheter drainage and urokinase pericardial lavage in the treatment of acute tuberculous pericarditis. Methods: From January 1996 to May 2009 in our hospital 48 cases of clinically diagnosed acute tuberculous pericarditis with moderate to large effusion patients (duration shorter than January), 28 males and 20 females, Aged 14 to 72 years old. Randomly divided into two groups, the treatment group (conventional anti-TB, glucocorticoid therapy based on the catheter placed indwelling central venous drainage plus pericardial urokinase lavage treatment) or control group (conventional anti-TB, glucocorticoid therapy On the basis of indwelling central venous catheter drainage). The complications such as pericardial hemorrhage, arrhythmia and infection in the two groups were observed and compared. The changes of pericardium thickness before and after treatment, the residual pericardial effusion during extubation, and the complications of follow-up by telephone and echocardiography , The deadline for the follow-up is May 2010. The follow-up period was 11 to 132 months. Results: Compared with the control group, there was significant difference (P <0.05) in the change of pericardium thickness between the treatment group and the control group after treatment for one week and two weeks, residual fluid accumulation during extubation and constriction of the pericardium (P <0.05) No significant difference (P> 0.05). All patients in the treatment group had no pericardial bleeding and systemic bleeding complications after urokinase treatment. None of the patients died during the follow-up period. One case (4.2%) and 8 cases (33.3%) in the treatment group and the control group had pericardial constriction. Conclusion: Indwelling central venous catheter plus urokinase lavage is safe and feasible for acute tuberculous pericarditis. Pericardial effusion is complete, extubation time is earlier, pericardial thickening is significantly reduced, pericardial adhesion is reduced, which can effectively prevent Patients with pericardial narrowing occurred.