Sagristà-Sauleda J, Barrabés J A, Permanyer-Miralda G, Soler-Soler J
Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain.
J Am Coll Cardiol. 1993 Nov 15;22(6):1661-5. doi: 10.1016/0735-1097(93)90592-o.
The purpose of this study was to review the features of purulent pericarditis in patients from a general hospital during a recent 20-year period.
Although studies published from 1974 to 1977 suggested a changing spectrum for purulent pericarditis, this view has not been proved.
We retrospectively evaluated the records of 33 patients from one general hospital who had a diagnosis of purulent pericarditis during the period 1972 to 1991. All autopsy protocols from the same period were also reviewed. In 19 patients (group I), the condition was diagnosed during life; in 14 (group II), it was identified at autopsy.
In group I, the possible sources of pericardial infection were identified in 17 patients; pneumonia (6 patients) was the most common source. Empyema was present in 10 patients; 15 had cardiac tamponade. The most common microorganisms were streptococci, pneumococci and staphylococci. Six patients developed constrictive pericarditis and required pericardiectomy. Three patients died, 1 patient was lost to follow up and 15 patients had a favorable outcome at a mean follow-up interval of 35 months. In group II, the clinical diagnoses included pneumonia (five patients) among other infections, with empyema in six patients. Purulent pericarditis was probably the direct cause of death in two patients.
In our experience, the spectrum of purulent pericarditis has not changed in recent years. Many patients do not have the classical findings of pericarditis, and diagnosis is made only at autopsy or after tamponade has developed. Empyema remains a common predisposing condition. Purulent pericarditis is still a severe disease, but its prognosis is excellent in patients who can be discharged from the hospital.
本研究旨在回顾一家综合医院近20年期间脓性心包炎患者的特征。
尽管1974年至1977年发表的研究表明脓性心包炎的疾病谱有所变化，但这一观点尚未得到证实。
我们回顾性评估了一家综合医院1972年至1991年期间诊断为脓性心包炎的33例患者的记录。同时也查阅了同一时期所有的尸检报告。19例患者（I组）在生前被诊断；14例（II组）在尸检时被发现。
I组中，17例患者的心包感染可能来源得以确定；肺炎（6例患者）是最常见的来源。10例患者有脓胸；15例有心脏压塞。最常见的微生物是链球菌、肺炎球菌和葡萄球菌。6例患者发展为缩窄性心包炎并需要心包切除术。3例患者死亡，1例患者失访，15例患者在平均35个月的随访期内预后良好。II组中，临床诊断包括肺炎（5例患者）及其他感染，6例患者有脓胸。脓性心包炎可能是2例患者的直接死因。
根据我们的经验，近年来脓性心包炎的疾病谱并未改变。许多患者没有心包炎的典型表现，仅在尸检时或心脏压塞发生后才得以诊断。脓胸仍然是常见的诱发因素。脓性心包炎仍然是一种严重的疾病，但对于能够出院的患者，其预后良好。
