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目的观察中量以上结核性心包积液经皮穿刺留置导管加尿激酶灌洗治疗减少心包粘连和缩窄的临床效果。方法临床确诊为结核性心包积液,在超声心动图定位下进行常规心包穿刺留置导管引流4～7d,用生理盐水及尿激酶10万U单位加入20～100ml生理盐水中保留2h后再全部排出,观察3d到流管不再有液体流出后,拨出引流管。同时用链霉素、异烟肼等规则抗痨化疗,辅以营养支持等全身治疗。结果临床心包压塞症状完全缓解,胸透及胸片复查心影基本正常,复查超声心动图心包液性暗区消失38例,少量6例,随访半年至3年,无缩窄性心包炎发生。结论本方法操作简便、技术安全、无不良反应、结合规则抗痨化疗等治疗,是防治结核性心包炎粘连缩窄的有效方法之一。
Objective To observe the clinical effect of percutaneous catheterization plus urokinase lavage to reduce pericardial adhesions and narrowing of tuberculous pericardial effusion. Methods The clinical diagnosis of tuberculous pericardial effusion, under echocardiographic positioning conventional catheterization catheter drainage 4 ~ 7d, with normal saline and urokinase 100,000 U units by adding 20 ~ 100ml saline for 2h and then discharged , Observed 3d to the flow tube is no longer liquid outflow, set aside the drainage tube. At the same time with streptomycin, isoniazid and other anti-tuberculosis chemotherapy, supplemented by nutritional support systemic treatment. Results The clinical symptoms of pericardial embolism were completely relieved. The chest X-ray and chest radiography were normal. The echocardiographic pericardial fluid disappeared in 38 cases and a small amount in 6 cases. The patients were followed up for 6 months to 3 years without constrictive pericarditis . Conclusion The method is simple, safe and safe, without adverse reactions, combined with anti-tuberculosis chemotherapy and other treatment is effective prevention and treatment of tuberculous pericarditis adhesions is one of the effective methods.