Chen W T, Chen C C, Yu F C, Shen C Y, Lin C C
Division of Cardiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C.
Zhonghua Yi Xue Za Zhi (Taipei). 1996 Jul;58(1):7-11.
The prevalence of tuberculosis has declined with advanced antituberculous chemotherapy. However, the occurrence of subsequent constrictive pericarditis in tuberculosis has not reduced. Clinical progress of tuberculous pericarditis was investigated in patients receiving antituberculous chemotherapy.
Thirteen patients with tuberculous pericarditis (11 men and 2 women aged 14 to 86 years [mean 60.0 +/- 17.0]), treated initially with antituberculous medications were analyzed. All patients underwent pericardiocentesis on admission following echocardiography.
Dyspnea was the most common clinical pictures. Bloody effusion fluids were noted in 10 patients. Moreover, the lymphocytic fluids were present in 78% of all patients. The neutrophilic fluids tended to have a bloody color, and there was progress to constrictive pericarditis even for those on anti-tuberculous chemotherapy. Five patients with subsequent constrictive pericarditis received pericardiectomy within 3.5 months of admission. Three of them received pericardiectomy later, despite pericardial window procedure.
Follow-up by echocardiogram is necessary within three months after commencing medical treatment because of the high incidence of progression constrictive pericarditis despite aggressive medical treatment. Pericardiectomy seems to be the only solution to the catastrophic outcome of constrictive pericarditis.
随着抗结核化疗的进展，结核病的患病率有所下降。然而，结核病后继发缩窄性心包炎的发生率并未降低。我们对接受抗结核化疗的结核性心包炎患者的临床进展进行了研究。
分析了13例结核性心包炎患者（11例男性和2例女性，年龄14至86岁[平均60.0±17.0]），这些患者最初接受抗结核药物治疗。所有患者在入院后经超声心动图检查后均接受了心包穿刺术。
呼吸困难是最常见的临床表现。10例患者出现血性积液。此外，78%的患者积液为淋巴细胞性。中性粒细胞性积液往往呈血性，即使接受抗结核化疗的患者也会进展为缩窄性心包炎。5例继发缩窄性心包炎的患者在入院后3.5个月内接受了心包切除术。其中3例患者尽管接受了心包开窗术，但后来仍接受了心包切除术。
由于尽管积极治疗，但进展为缩窄性心包炎的发生率较高，因此在开始治疗后三个月内有必要通过超声心动图进行随访。心包切除术似乎是解决缩窄性心包炎灾难性后果的唯一办法。
