Thébaud B, Sidi D, Kachaner J
Service de cardiopédiatrie, hôpital Necker-Enfants-Malades, Paris, France.
Arch Pediatr. 1996 Nov;3(11):1084-90. doi: 10.1016/s0929-693x(96)89513-3.
Purulent pericarditis is rare in developed countries, but its prognosis is regarded as serious. Early diagnosis and appropriate treatment should prevent complications.
Among the 119 pericarditis without congenital cardiopathy admitted in our pediatric cardiology unit between 1979 and 1994, 19 were purulent. The mean age of these 13 boys and six girls was 3 years (range: 3 months to 10 years). Symptoms always pointed to a chest disease whether pericarditis occurred first (n = 13) or it complicated evolution of a known infectious process (n = 6). Tamponnade was present in seven infants upon admission and required urgent pericardiocentesis or drainage. An extrapericardial infectious site was found in 11 cases: six pulmonary infections, three osteomyelitis, one cellulitis and one sinusitis. An organism was isolated in 17 cases, 14 times in the pericardial fluid, eight times on blood culture. The identified bacteria were: Staphylococcus aureus (n = 6), Haemophilus influenzae (n = 4), Streptococcus A (n = 3), Streptococcus pneumoniae (n = 3), Meningococcus (n = 1). Treatment consisted of intra-venous antibiotics associated 15 times to surgical drainage of the pericardium. One infant had no pericardiocentesis and no drainage because he presented late with constrictive pericarditis and needed pericardectomy. All infants healed but four developed contrictive pericarditis and required pericardectomy; none of these four patients had early drainage (two had no drainage at all). Pericardectomy, carried out between 2 and 6 months after the beginning of pericarditis with adiastolic signs and pericardial thickening, permitted healing in all cases and disappearance of all cardiac symptoms.
Early diagnosis and treatment of purulent pericarditis, especially early pericardial drainage, are the best ways of avoiding constriction.
化脓性心包炎在发达国家较为罕见，但其预后被认为很严重。早期诊断和恰当治疗应可预防并发症。
1979年至1994年间，在我们儿科心脏病科收治的119例无先天性心脏病的心包炎患者中，19例为化脓性心包炎。这13名男孩和6名女孩的平均年龄为3岁（范围：3个月至10岁）。无论心包炎是首发（n = 13）还是已知感染过程演变所致的并发症（n = 6），症状均指向胸部疾病。7名婴儿入院时存在心包填塞，需要紧急心包穿刺或引流。11例发现心包外感染部位：6例肺部感染、3例骨髓炎、1例蜂窝织炎和1例鼻窦炎。17例分离出病原体，14次在心包液中，8次在血培养中。鉴定出的细菌有：金黄色葡萄球菌（n = 6）、流感嗜血杆菌（n = 4）、A组链球菌（n = 3）、肺炎链球菌（n = 3）、脑膜炎球菌（n = 1）。治疗包括静脉使用抗生素，15次联合心包外科引流。1名婴儿未进行心包穿刺和引流，因为他出现缩窄性心包炎较晚，需要进行心包切除术。所有婴儿均痊愈，但4例发展为缩窄性心包炎，需要进行心包切除术；这4例患者均未早期引流（2例根本未引流）。在心包炎开始后2至6个月，出现舒张期体征和心包增厚时进行心包切除术，所有病例均愈合，所有心脏症状消失。
化脓性心包炎早期诊断和治疗，尤其是早期心包引流，是避免缩窄的最佳方法。
