Tsang Teresa S M, Barnes Marion E, Gersh Bernard J, Bailey Kent R, Seward James B
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Am J Cardiol. 2003 Mar 15;91(6):704-7. doi: 10.1016/s0002-9149(02)03408-2.
There is a paucity of outcome data on patients with idiopathic pericardial effusion requiring intervention. All patients who had clinically significant pericardial effusion confirmed by echocardiography and requiring interventions between 1979 and 2000 were identified through the Echo-guided Pericardiocentesis Registry and Echocardiography and Surgical Databases. Clinical data and outcomes were obtained by review of medical records and surveys. The study population consisted of 92 patients (mean age 59 +/- 15 years). Five patients were referred directly for pericardiectomy (3 had effusion in the context of chronic relapsing pericarditis, 2 had effusive constrictive disease), and 87 underwent echo-guided pericardiocentesis as their initial treatment. In 47 of these patients, primary management involved extended pericardial catheter drainage, which was associated with a trend to lower recurrence rates than in those without catheter drainage (p = 0.052). Three patients had transient right ventricular entry with no sequelae, and 7 patients (8%) later had surgical pericardiectomy because of the recurrence of effusion, 2 of whom were also found to have evidence of effusive constrictive disease during surgery. One patient had bleeding after pericardiectomy that required repeat thoracotomy. Mean follow-up of the cohort was 3.8 +/- 4.3 years. For most patients with clinically significant idiopathic pericardial effusion requiring intervention, echo-guided pericardiocentesis was the definitive treatment. Pericardiectomy was necessary for patients in whom effusion occurred in the context of effusive constrictive disease, chronic relapsing pericarditis, or recurrent effusion despite pericardiocentesis. The prognosis for the cohort was favorable, and survival did not appear to differ from that of the general population (p = 0.372).
关于需要干预的特发性心包积液患者的预后数据较少。通过超声心动图引导心包穿刺登记处以及超声心动图和外科数据库，确定了1979年至2000年间所有经超声心动图证实有临床显著心包积液且需要干预的患者。通过查阅病历和进行调查获取临床数据和预后情况。研究人群包括92例患者（平均年龄59±15岁）。5例患者直接被转诊进行心包切除术（3例在慢性复发性心包炎背景下有积液，2例有渗出性缩窄性疾病），87例接受了超声心动图引导心包穿刺作为初始治疗。在这些患者中，47例的主要治疗方法是延长心包导管引流，与未进行导管引流的患者相比，其复发率有降低趋势（p = 0.052）。3例患者出现短暂性右心室穿入且无后遗症，7例患者（8%）后来因积液复发接受了外科心包切除术，其中2例在手术中还被发现有渗出性缩窄性疾病的证据。1例患者在心包切除术后出血，需要再次开胸手术。该队列的平均随访时间为3.8±4.3年。对于大多数有临床显著特发性心包积液且需要干预的患者，超声心动图引导心包穿刺是确定性治疗方法。对于在渗出性缩窄性疾病、慢性复发性心包炎背景下出现积液或尽管进行了心包穿刺仍有积液复发的患者，心包切除术是必要的。该队列的预后良好，生存率似乎与一般人群无差异（p = 0.372）。
