Round A, Hamilton W
Queen Elizabeth Central Hospital, Blantyre, Malawi.
Q J Med. 1990 Jul;76(279):763-6.
A consecutive series of 25 Malawian patients with tamponade secondary to tuberculosis were compared to 25 patients with congestive cardiac failure, without pericardial effusion in a retrospective study. More patients with tamponade had an impalpable apex beat (21/1), pulsus paradoxus (13/0), soft heart sounds (13/2), paradoxical rise in jugular venous pressure (6/0), and fewer had a murmur (1/14). All these results are significant (p less than 0.05) by the chi 2 test with Yates' correction. The presence of two or more of these discriminating physical signs has a positive predictive value of 75 per cent, and a negative predictive value of 99.5 per cent for the diagnosis of tamponade. Clinical diagnosis of tamponade by primary health care personnel in Malawi should be possible, and lead to earlier treatment.
在一项回顾性研究中，将连续的25例因结核病导致心包填塞的马拉维患者与25例无心包积液的充血性心力衰竭患者进行了比较。心包填塞患者中，心尖搏动触诊不清者更多（21/1）、存在奇脉者更多（13/0）、心音柔和者更多（13/2）、颈静脉压反常升高者更多（6/0），而有杂音者更少（1/14）。经Yates校正的卡方检验显示，所有这些结果均具有显著性（p小于0.05）。出现两种或更多这些有鉴别意义的体征，对心包填塞诊断的阳性预测值为75%，阴性预测值为99.5%。马拉维的初级卫生保健人员应能够对心包填塞进行临床诊断，并实现更早治疗。
