Tingle Leslie E, Molina Daniel, Calvert Charles W
Baylor Family Medicine Residency at Garland, Garland, Texas, USA.
Am Fam Physician. 2007 Nov 15;76(10):1509-14.
Although acute pericarditis is most often associated with viral infection, it may also be caused by many diseases, drugs, invasive cardiothoracic procedures, and chest trauma. Diagnosing acute pericarditis is often a process of exclusion. A history of abrupt-onset chest pain, the presence of a pericardial friction rub, and changes on electrocardiography suggest acute pericarditis, as do PR-segment depression and upwardly concave ST-segment elevation. Although highly specific for pericarditis, the pericardial friction rub is often absent or transient. Auscultation during end expiration with the patient sitting up and leaning forward increases the likelihood of observing this physical finding. Echocardiography is recommended for most patients to confirm the diagnosis and to exclude tamponade. Outpatient management of select patients with acute pericarditis is an option. Complications may include pericardial effusion with tamponade, recurrence, and chronic constrictive pericarditis. Use of colchicine as an adjunct to conventional nonsteroidal anti-inflammatory drug therapy for acute viral pericarditis may hasten symptom resolution and reduce recurrences.
虽然急性心包炎最常与病毒感染相关，但它也可能由许多疾病、药物、侵入性心胸手术及胸部创伤引起。诊断急性心包炎往往是一个排除过程。突发胸痛病史、心包摩擦音的存在以及心电图变化提示急性心包炎，PR段压低和向上凹的ST段抬高也提示急性心包炎。心包摩擦音虽对心包炎具有高度特异性，但常不存在或为一过性。患者坐起并前倾时在呼气末听诊可增加观察到这一体征的可能性。推荐对大多数患者进行超声心动图检查以确诊并排除心包填塞。部分急性心包炎患者可选择门诊治疗。并发症可能包括心包积液伴心包填塞、复发及慢性缩窄性心包炎。对于急性病毒性心包炎，使用秋水仙碱辅助传统非甾体抗炎药治疗可能会加速症状缓解并减少复发。
