Département d'Anesthésie et Réanimation Chirurgicale, Hôpital Bichat Claude Bernard, Assistance Publique - Hôpitaux de paris, Paris 7 University (Denis Diderot), 46 rue Henri-Huchard, 75877 Paris Cedex 18, France.
Crit Care. 2011 Apr 20;15(2):220. doi: 10.1186/cc10022.
Purulent pericarditis (PP) is a potentially life-threatening disease. Reported mortality rates are between 20 and 30%. Constrictive pericarditis occurs over the course of PP in at least 3.5% of cases. The frequency of persistent PP (chronic or recurrent purulent pericardial effusion occurring despite drainage and adequate antibiotherapy) is unknown because this entity was not previously classified as a complication of PP. No consensus exists on the optimal management of PP. Nevertheless, the cornerstone of PP management is complete eradication of the focus of infection. In retrospective studies, compared to simple drainage, systematic pericardiectomy provided a prevention of constrictive pericarditis with better clinical outcome. Because of potential morbidity associated with pericardiectomy, intrapericardial fibrinolysis has been proposed as a less invasive method for prevention of persistent PP and constrictive pericarditis. Experimental data demonstrate that fibrin formation, which occurs during the first week of the disease, is an essential step in the evolution to constrictive pericarditis and persistent PP. We reviewed the literature using the MEDLINE database. We evaluated the clinical efficacy, outcome, and complications of pericardial fibrinolysis. Seventy-four cases of fibrinolysis in PP were analysed. Pericarditis of tuberculous origin were excluded. Among the 40 included cases, only two treated by late fibrinolysis encountered failure requiring pericardiectomy. No patient encountered clinical or echocardiographic features of constriction during follow-up. Only one serious complication was described. Despite the lack of definitive evidence, potential benefits of fibrinolysis as a less invasive alternative to surgery in the management of PP seem promising. Early consideration should be given to fibrinolysis in order to prevent both constrictive and persistent PP. Nevertheless, in case of failure of fibrinolysis, pericardiectomy remains the primary option for complete eradication of infection.
化脓性心包炎（PP）是一种潜在的危及生命的疾病。据报道，死亡率在 20%至 30%之间。缩窄性心包炎在至少 3.5%的病例中发生于 PP 病程中。持续性 PP（尽管引流和充分的抗生素治疗仍持续存在化脓性心包积液的慢性或复发性）的频率未知，因为这种情况以前并未被归类为 PP 的并发症。目前尚无关于 PP 最佳治疗方法的共识。然而，PP 治疗的基石是完全消除感染灶。在回顾性研究中，与单纯引流相比，系统性心包切除术可预防缩窄性心包炎，并获得更好的临床结局。由于心包切除术可能带来的潜在发病率，心包内纤维蛋白溶解已被提议作为预防持续性 PP 和缩窄性心包炎的一种侵袭性较小的方法。实验数据表明，在疾病的第一周发生的纤维蛋白形成是发展为缩窄性心包炎和持续性 PP 的重要步骤。我们使用 MEDLINE 数据库检索文献。我们评估了纤维蛋白溶解在心包炎治疗中的临床疗效、结局和并发症。分析了 74 例 PP 中的纤维蛋白溶解病例。排除了结核性心包炎。在纳入的 40 例病例中，仅 2 例接受晚期纤维蛋白溶解治疗的患者失败，需要心包切除术。在随访期间，没有患者出现缩窄的临床或超声心动图特征。仅描述了 1 例严重并发症。尽管缺乏确凿的证据，但纤维蛋白溶解作为手术治疗 PP 的一种侵袭性较小的替代方法似乎具有潜在的益处。为了预防缩窄性和持续性 PP，应尽早考虑纤维蛋白溶解。然而，如果纤维蛋白溶解失败，心包切除术仍然是彻底消除感染的主要选择。
