Goldstein D H, Nagar C, Srivastava N, Schacht R A, Ferris F Z, Flowers N C
Chest. 1977 Dec;72(6):744-7. doi: 10.1378/chest.72.6.744.
The danger of cardiac tamponade occurring when pericarditis is accompanied by pericardial effusion, as opposed merely to the presence of a friction rub without effusion, has been unclear. Forty patients on hemodialysis were studied by physical examination, chest x-ray film, and echocardiography for evidence of pericarditis and pericardial effusion. Only two patients developed a friction rub during the study and were placed on regional heparin. Ten of 11 patients who were positive on echocardiogram for pericardial effusion had unremarkable physical examinations. These 11 patients had cardiomegaly as noted on chest x-ray examination. Eighteen of 25 patients without effusion also had cardiomegaly on chest x-ray film. No patient remaining on systemic heparin and having a pericardial effusion developed cardiovascular complications during hemodialysis. This study suggests that while many patients on longterm hemodialysis have pericardial effusion undiagnosed on the basis of physical examination, but noted on echocardiogram, special precautions to prevent tamponade during hemodialysis are not necessary. Also, posterior-anterior chest x-ray film showing a normal-sized heart will usually exclude significant pericardial effusion.
心包炎伴有心包积液时发生心脏压塞的危险性，与仅有摩擦音而无积液的情况相比，一直尚不明确。对40例接受血液透析的患者进行了体格检查、胸部X线片及超声心动图检查，以寻找心包炎和心包积液的证据。研究期间仅有2例患者出现摩擦音，并接受了局部肝素治疗。超声心动图显示心包积液阳性的11例患者中，10例体格检查无异常。这11例患者胸部X线检查显示心脏增大。25例无积液的患者中，18例胸部X线片也显示心脏增大。继续接受全身肝素治疗且有心包积液的患者在血液透析期间均未发生心血管并发症。本研究提示，虽然许多长期接受血液透析的患者存在体格检查未诊断出但超声心动图可发现的心包积液，但在血液透析期间无需采取特殊预防措施来防止心脏压塞。此外，后前位胸部X线片显示心脏大小正常通常可排除大量心包积液。
