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目的总结分析缩窄性心包炎的诊断和治疗经验。方法回顾性分析1978年1月至2006年3月期间84例缩窄性心包炎的临床资料。主要根据超声心动图检查来确定诊断。全部采用胸骨正中切口施行心包剥脱术,因术中心脏破裂出血和合并房间隔缺损,在体外循环下完成手术2例。结果1例因严重低心排综合征死亡,死亡率1.2%。术后并发低心排综合征30例,肺部感染6例,纵隔感染、胸骨哆开2例。84例中有79例获得随访,随访率94.0%。心功能恢复到Ⅰ级者62例,恢复到Ⅱ级者17例。结论根据临床症状、结合超声心动图等辅助检查,一般可正确诊断此病;心包剥脱术仍是治疗此病唯一有效的方法;早期诊断、及时手术、充分合理的心包剥脱范围、正确的围术期处理是手术成功和提高远期疗效的关键。
Objective To summarize and analyze the experience of diagnosis and treatment of constrictive pericarditis. Methods The clinical data of 84 cases of constrictive pericarditis were retrospectively analyzed from January 1978 to March 2006. Mainly based on echocardiography to confirm the diagnosis. All sternal midline incision with pericardial exfoliation operation, due to intraoperative rupture of the heart and the merger of atrial septal defect, surgery completed in 2 cases under cardiopulmonary bypass. Results One patient died of severe low cardiac output syndrome with a mortality rate of 1.2%. Postoperative low cardiac output syndrome in 30 cases, 6 cases of pulmonary infection, mediastinal infection, sternum open in 2 cases. 79 of 84 cases were followed up with a follow-up rate of 94.0%. Heart function recovered to grade Ⅰ in 62 cases, restored to grade Ⅱ in 17 cases. Conclusion According to the clinical symptoms and combined with echocardiography and other auxiliary examination, the diagnosis of the disease can be correctly diagnosed. The only effective method for the treatment of this disease is the pericardial exfoliation surgery. The early diagnosis, timely operation, adequate and reasonable range of pericardial exfoliation, Period treatment is the key to successful operation and long-term efficacy.