心包积液47例临床分析
摘要
目的：分析心包积液患者的一般情况、症状体征、辅助检查结果,尤其是病因构成的特点,从而提高临床诊断水平；
方法：浙江大学医学院附属第一医院2009.年1月1日—2010年12月31日入院,诊断为“心包积液待查”的住院患者共47例进行回顾性分析。
结果：通过心超或CT确诊的心包积液患者中,明确诊断者40例,病因构成依次为：肿瘤性(12例,25.53%),结核性(10例,21.28%),心力衰竭性(9例,19.15%),非特异性心包炎(5例,10.64%),系统性红斑狼疮(1例,2.13%),甲状腺功能减退性(1例,2.13%),限制性心肌病(1例,2.13%),右冠状窦瘤破入右室(1例,2.13%)；其余的7例(14.89%)心包积液患者未能找到明确的原因。肿瘤性、结核性心包积液发病率最高,多为血性,且常为中-大量积液,而其他原因引起的心包积液呈血性者相对少见,且多为少量。国内外有很多研究都涉及心包积液的检查、治疗等方面,给我们提供了诸多启示。
结论：随着诊疗水平的提高,心包积液的检出率越来越高。心超是诊断心包积液最常用的方法,其安全、灵敏、有效、可靠、无创,还可以同时检查到心脏大血管的内部结构有无异常,辅助诊断。就目前的医疗水平,心包积液的确诊已不困难,重要的是需要明确心包积液的病因,从而指导治疗。病因的明确需要结合患者的临床表现和辅助检查结果综合分析,其中,心包穿刺、心包活检是明确心包积液性质及原因的重要方式,但因为其为有创性操作,并发症多且较严重,所以其在临床的运用较有限。
Objective:To investigate the general stasis, symptoms, physical exhibitions, assisted examination results, especially the feature of the causes in the patients with pericardial effusion,and we can promote the diagnosis skills in clinical practice.
Methods:Retrospective analysis of47cases with pericardial effusion in the first affiliated hospital of ZheJiang University from Jan,2009to Dec,2010.
Results:Among the patients with pericardial effusion who get diagnoses by ultrasonic cardiogram or CT scan,40cases get the definite causes, and the causes included tumor(12cases,25.53%),tuberculosis(10cases,21.28%),heart,failure,(9cases,19.15%),non specific,pericarditis(5cases,10.64%),SLE(1case,2.13%),hypothyroidism(1case,2.13%),r estrictive cardiomyopathy(lcase,2.13%),right coronary aneurysm rupture into right ventricle(1case,2.13%).While7other cases(14.89%)have find no definite etiological factor. The neoplastic pericardial effusion and tuberlosis pericardial effusion have the first and second highest incidence, and most of them are blood like and medium-large in volume, at the same time,the pericardial effusion with other causes seldom have the appearance of blood like, and most of them are little in volume.Many researches at home and abroad get involved with the examinations、s treatments and many other aspects about pericardial effusion, which gives us a lot ot hints.
Conclusions:With the development of the diagnosis and treatment standard, the diagnosis ratio of pericardial effusion is increasingly high. Ultrasonic cardiogram is the most commonly used method to diagnose pericardial effusion, because it is safe, sensitive, effective, reliable, and noninvasive, and it can inspect the abnormality of the cardiovascular internal structure which can help diagnosis. With the current medical technology, the diagnosis of pericardial effusion has not been difficult, it's more important to make sure of the cause, in order to guide treatment. It is needed to combine the clinical appearance and examination results to get a comprehensive analysis. Among the examinations, pericardial puncture and pericardial biopsy are the significant way to know the property and cause of pericardial effusion, however, they are invasive operations with many serious complications, which destined their limited use in clinical practice.
方法：浙江大学医学院附属第一医院2009.年1月1日—2010年12月31日入院,诊断为“心包积液待查”的住院患者共47例进行回顾性分析。
结果：通过心超或CT确诊的心包积液患者中,明确诊断者40例,病因构成依次为：肿瘤性(12例,25.53%),结核性(10例,21.28%),心力衰竭性(9例,19.15%),非特异性心包炎(5例,10.64%),系统性红斑狼疮(1例,2.13%),甲状腺功能减退性(1例,2.13%),限制性心肌病(1例,2.13%),右冠状窦瘤破入右室(1例,2.13%)；其余的7例(14.89%)心包积液患者未能找到明确的原因。肿瘤性、结核性心包积液发病率最高,多为血性,且常为中-大量积液,而其他原因引起的心包积液呈血性者相对少见,且多为少量。国内外有很多研究都涉及心包积液的检查、治疗等方面,给我们提供了诸多启示。
结论：随着诊疗水平的提高,心包积液的检出率越来越高。心超是诊断心包积液最常用的方法,其安全、灵敏、有效、可靠、无创,还可以同时检查到心脏大血管的内部结构有无异常,辅助诊断。就目前的医疗水平,心包积液的确诊已不困难,重要的是需要明确心包积液的病因,从而指导治疗。病因的明确需要结合患者的临床表现和辅助检查结果综合分析,其中,心包穿刺、心包活检是明确心包积液性质及原因的重要方式,但因为其为有创性操作,并发症多且较严重,所以其在临床的运用较有限。
Objective:To investigate the general stasis, symptoms, physical exhibitions, assisted examination results, especially the feature of the causes in the patients with pericardial effusion,and we can promote the diagnosis skills in clinical practice.
Methods:Retrospective analysis of47cases with pericardial effusion in the first affiliated hospital of ZheJiang University from Jan,2009to Dec,2010.
Results:Among the patients with pericardial effusion who get diagnoses by ultrasonic cardiogram or CT scan,40cases get the definite causes, and the causes included tumor(12cases,25.53%),tuberculosis(10cases,21.28%),heart,failure,(9cases,19.15%),non specific,pericarditis(5cases,10.64%),SLE(1case,2.13%),hypothyroidism(1case,2.13%),r estrictive cardiomyopathy(lcase,2.13%),right coronary aneurysm rupture into right ventricle(1case,2.13%).While7other cases(14.89%)have find no definite etiological factor. The neoplastic pericardial effusion and tuberlosis pericardial effusion have the first and second highest incidence, and most of them are blood like and medium-large in volume, at the same time,the pericardial effusion with other causes seldom have the appearance of blood like, and most of them are little in volume.Many researches at home and abroad get involved with the examinations、s treatments and many other aspects about pericardial effusion, which gives us a lot ot hints.
Conclusions:With the development of the diagnosis and treatment standard, the diagnosis ratio of pericardial effusion is increasingly high. Ultrasonic cardiogram is the most commonly used method to diagnose pericardial effusion, because it is safe, sensitive, effective, reliable, and noninvasive, and it can inspect the abnormality of the cardiovascular internal structure which can help diagnosis. With the current medical technology, the diagnosis of pericardial effusion has not been difficult, it's more important to make sure of the cause, in order to guide treatment. It is needed to combine the clinical appearance and examination results to get a comprehensive analysis. Among the examinations, pericardial puncture and pericardial biopsy are the significant way to know the property and cause of pericardial effusion, however, they are invasive operations with many serious complications, which destined their limited use in clinical practice.
引文
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