Bozbuga Nilgun, Erentug Vedat, Eren Ercan, Erdogan Hasan Basri, Kirali Kaan, Antal Arzu, Akinci Esat, Yakut Cavat
Department of Cardiovascular Surgery, Kosuyolu Heart and Research Hospital, Istanbul, Turkey.
Tex Heart Inst J. 2003;30(3):180-5.
We performed this study to determine the predictors of early and long-term survival in the surgical treatment of tuberculous pericarditis and to examine the risks of pericardiectomy and the functional outcome in patients after surgery. A retrospective analysis was undertaken in 36 consecutive patients, 26 female and 10 male, with a mean age 32.2 +/- 16.3, who underwent pericardiectomy for chronic constrictive pericarditis from February 1985 to February 2002. All patients received antitubercular therapy in the postoperative period. The operative mortality rate was 6% (2 patients); the cause of death in both cases was severe low-cardiac-output syndrome. Nonfatal intraoperative complications affected 3 patients (8%). The median stay in the intensive care unit was 3.7 +/- 3.1 days. The median hospital stay was 14 +/- 2.6 days. The median ventilation time was 11.9 +/- 1.8 hours. The median volume of blood transfused was 2.1 +/- 1.6 units. Advanced age, atrial fibrillation, concomitant tricuspid insufficiency, inotropic support and low cardiac output were significant negative predictors of survival, according to univariate analysis. There were 4 late deaths. Actuarial survival at 5 years was 75.9% +/- 9.14%. At the 1-year follow-up examination, improved functional status was noted in 88% of patients. We suggest that pericardiectomy be performed early and as radically as possible, in an effort to prevent chronic illness. A combination of chemotherapy and surgery yields gratifying results in the treatment of tuberculous pericarditis.
我们开展这项研究以确定结核性心包炎外科治疗的早期和长期生存预测因素，并探讨心包切除术的风险及术后患者的功能结局。对1985年2月至2002年2月期间因慢性缩窄性心包炎接受心包切除术的36例连续患者进行了回顾性分析，其中女性26例，男性10例，平均年龄32.2±16.3岁。所有患者术后均接受抗结核治疗。手术死亡率为6%（2例患者）；两例患者的死亡原因均为严重的低心排血量综合征。3例患者（8%）出现非致命性术中并发症。重症监护病房的中位住院时间为3.7±3.1天。中位住院时间为14±2.6天。中位通气时间为11.9±1.8小时。中位输血量为2.1±1.6单位。单因素分析显示，高龄、心房颤动、合并三尖瓣关闭不全、使用正性肌力药物支持及低心排血量是生存的显著负性预测因素。有4例晚期死亡。5年精算生存率为75.9%±9.14%。在1年随访检查中，88%的患者功能状态有所改善。我们建议尽早且尽可能彻底地进行心包切除术，以预防慢性病。化疗与手术相结合在结核性心包炎的治疗中取得了令人满意的效果。
