Pascual Turón R, Pascual Figueras J M, Garcia Rafanell J M, Marqués Vidal A, Franquesa Salvador J
Med Clin (Barc). 1979 Feb 10;72(3):89-92.
Numerous therapeutic schemes have been proposed for pericarditis, whether or not accompanied by pericardial effusion in patients with terminal chronic renal insufficiency of subjects on periodic hemodialysis. All of the authors agree that dialysis must be initiated, or at least must not be interrupted once it is begun. There is some disagreement over the system that should be used (peritoneal dialysis or hemodialysis). Anti-inflammatory drugs have been used in association, since the condition is an inflammatory disease. Five episodes of pericarditis with daily hemodialysis and local heparine were treated, plus five other cases with the addition of 3 mg indomethacin/kg/day for 8 days. No secondary effects of indomethacin were reported. A definite reduction in the duration of pain, fever, pericardial rub, and increase in the size of the cardiac shadow was seen in the episodes treated with the association of indomethacin. This furthermore involved the number of days the patient was subjected to hemodialysis. Partial pericardiectomy was practiced on two patients not treated with indomethacin. The later course of the patients treated with indomethacin was more favorable since pericardial effusion did not lead to significant hemodynamic symptoms. There were no recurrences or other complications.
对于终末期慢性肾功能不全且接受定期血液透析的患者,无论是否伴有心包积液,针对心包炎已提出了众多治疗方案。所有作者均认同必须开始透析,或者一旦开始透析就绝不能中断。对于应采用的透析方式(腹膜透析或血液透析)存在一些分歧。鉴于该病症是炎症性疾病,已联合使用了抗炎药物。对5例每日进行血液透析并局部使用肝素治疗的心包炎病例进行了治疗,另外5例加用了3毫克吲哚美辛/千克/天,持续8天。未报告吲哚美辛的副作用。在联合使用吲哚美辛治疗的病例中,疼痛、发热、心包摩擦音的持续时间明显缩短,心影增大情况得到改善。这还减少了患者接受血液透析的天数。对2例未接受吲哚美辛治疗的患者实施了部分心包切除术。接受吲哚美辛治疗的患者后期病情更有利,因为心包积液未导致明显的血流动力学症状。未出现复发或其他并发症。