摘要
目的 研究心包腔内尿激酶灌洗结合心包引流能否预防感染渗出性心包炎患者心包缩窄的发生。方法 1993-2002年入选的94例感染渗出性心包炎患者(其中化脓性心包炎34例,结核性心包炎60例,病程均短于1个月),男44例,女50例,年龄为9-66(45.4±14.7)岁。依入选次序随机进入治疗组(常规治疗的基础上经皮导管心包内尿激酶灌洗)或对照组(仅接受常规治疗,包括心包引流)。心包内纤维蛋白溶解治疗(纤溶治疗)的近期效应通过无菌空气或泛影葡胺心包造影观察;远期效应通过电话问询及心脏超声随访,随访截止日期为2003年1月,随访期限为8-120(56.8±29.0)个月。结果 经皮心包内尿激酶治疗有利于心包积液彻底引流,明显减小心包厚度[治疗组治疗前为(3.1±1.6)mm,治疗后(1.6±1.0)mm,P<0.000;对照组治疗前(3.4±1.6)mm,治疗后(3.2±1.8)mm,P>0.05],同时消除心包局部的早期黏连。47例非血性心包积液患者中6例发生心包内出血,未见系统性出血及其他穿刺相关并发症。随访期内无一例发生心性死亡,治疗组及对照组分别有9例(19.1％)及27例(57.4％)发生心包缩窄。Cox模型生存分析提示心包内尿激酶治疗后发生心包缩窄的相对危险系数为0.185(P<0.000)。结论 经皮导管心包内尿激酶纤溶治疗能安全、有效地预防感染渗出性心包炎患者心包缩窄?
Objective The overall survival of patients with infections exudative pericarditis continues to be extremely poor due to high incidence of complicated pericardial constriction which can not be sufficiently prevented by conventional therapy. We hypothesized that intrapericardial urokinase along with pericardiocentesis could prevent pericardial constriction in these patients. Methods The 94 patients diagnosed as infections exudative pericarditis (34 patients with purulent pericarditis and 60 with tuberculous, the disease course of all patients was less than 1 month), 44 male and 50 female, aged from 9 to 66 (45.4±14. 7) years, were consecutively recruited from 1993 to 2002. All individuals were randomly given either intrapericardial urokinase along with conventional treatment or conventional treatment only (including pericardiocentesis). The dosage of urokinase ranged from 200 to 600 thousand (320±70) thousand unit. The immediate effects was detected by pericardiography with sterilized air and urografin as contrast media. The long-term investigation depended on the telephonic survey and echocardiographic examination. The deadline of follow-up was January 2003. The duration of following-up ranged from 8 to 120 months (56. 8±29.0) months. Results Percutaneous intrapericardial irrigation with urokinase promoted complete drainage of pericardial effusion, significantly reduced the thickness of pericardium [(3. 1±1.6) - (1. 6±1.0 )mm in study group vs. (3. 4±1. 6) - ( 3. 2±1. 8 )mm in control group, both P <0. 000, within study group and between two groups], and alleviated the adhesion. Intrapericardial bleeding related to fibrinolysis was found in 6 of 47 patients with non-blood pericardial effusion and no systemic bleeding and severe puncture-related complication were observed. In follow-up period, there was no cardiac death, and pericardialconstriction events were observed in 9 and 27 cases in study ( 19. 1% ) and control group (57. 4% ) , respectively. Cox analysis illustrated that urokinase could significantly reduce the appearance of pericardial constriction (relative hazard coefficient =0. 185, P < 0.000). Conclusions The early employment of intrapericardial fibrinolysis with urokinase and pericardiocentesis appears to be safe and effective in preventing the development of pericardial constriction .
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2004年第12期1118-1122,共5页
Chinese Journal of Cardiology
基金
陕西省科技基金资助项目(1995K11-G12)
