中心静脉导管留置治疗结核性心包炎临床评价.docVIP

中心静脉导管留置治疗结核性心包炎临床评价 　 作者：张芝辉　宗佩兰　袁艳珍　宋军福　张齐龙　肖绍武 【关键词】 ,结核性心包炎 　　【摘要】 目的 探讨中心静脉导管留置引流在治疗结核性心包炎伴有大量心包积液的应用价值。方法 将76例结核性渗出性心包炎患者随机分为A组和B组，均予以全身规则抗结核治疗。A组留置中心静脉导管引流及心包腔内注药，B组常规心包穿刺抽液及心包腔内注药。结果 A组与B组相比，两组间在消除心包填塞症状时间、退热时间、心包积液消失时间等方面差异均有非常显著性（Plt;0.01），A组优于B组；但两组引流量差异无统计学意义（P＞0.05）。结论 心包穿刺留置导管引流心包积液安全可行，操作简便，置管可靠，可迅速消除心包填塞症状，能及时彻底引流心包积液，疗效明显，无不良反应及损伤，降低了缩窄性心包炎的发生率，值得临床推广。 　　【关键词】 结核性心包炎；心包积液；心包穿刺术；中心静脉留置导管 　　【Abstract】 Objective To investigate the clinical value of detained central venous cathter for the treatment of tuberculous pericarditis,and to discover a new approach for preventing constrictive pericarditis.Methods 76 initial treatment patients were allocated randomizedly to A or B group.All the patients underwent regular anti-tuberculosis medication.Group A received the treatment of depositing a central venous catheter in pericardial cavity for Drainabe Therapy and intrapericardial injection.Group B received the treatment of removing fluids from the pericardial cavity with pericardiocentesis intermittently and intrapericardial injection.Results There were significant difference between the two groups with regatd the time that symptomatic disappeared,the time of defervescence,the time that pericardial effusion disappeared（P＜0.01）.Conclusion It is possible and safe to drain a lot of hydropericardium by pericardiocentesis and indwelling catheter.Successful cathter drainage can be achieved in all patients without any complications.The use of pericardial indwelling catheter drainage may leadto extensive complete drainage,rapid symptomatic disappeared,simple operation and reliable stabilizationand less constrictive pericarditis.It deserves to be spread. 　　【Key words】 tuberculous pericarditis;pericardial effusion;pericardiocentesis;central venous catheterization 　　我院1998~2005年收治76例结核性心包炎伴大量心包积液的患者，在全身抗痨的基础上，其中38例在B超引导下行心包穿刺并留置中心静脉导管引流加局部抗痨及时解除心包填塞的危险，减少了缩窄性心包炎的发生率，取得了满意疗效。现总结报告如下。 　　1 资料与方法 　　1.1 一般资料 76例结核性渗出性心包炎病人，其中男46例，女30例，年龄12~70岁，平均40.8岁。结核性心包炎诊断依据结核病史，临床表现及实验室检查