留置中心静脉导管加尿激酶心包内灌洗治疗急性结核性心包炎的临床疗效观察

目的：观察留置中心静脉导管引流加尿激酶心包内灌洗治疗急性结核性心包炎的疗效。方法：自1996年1月～2009年5月对我院48例临床确诊为急性结核性心包炎伴中到大量积液的患者（病程均短于1月）,男28例,女20例,年龄14～72岁。随机分为两组,治疗组（常规抗结核、肾上腺糖皮质激素治疗的基础上给予留置中心静脉导管心包引流加心包内尿激酶灌洗治疗）或对照组（常规抗结核、肾上腺糖皮质激素治疗基础上给予留置中心静脉导管引流）。观察并比较两组穿刺并发症（心包内出血、心律失常及感染）,治疗前、后心包膜厚度的变化,拔管时心包积液的残留量,以及通过电话问询及心脏超声随访并发症,随访截止日期为2010年5月。随访期限为11～132个月。结果：治疗组与对照组比较,治疗组治疗1周及2周后心包膜厚度的变化、拔管时积液残留量及发生心包缩窄方面有明显差异（P〈0.05）,穿刺相关并发症方面无明显差异（P〉0.05）。全部治疗组患者给予尿激酶治疗后未见心包内出血及系统性出血并发症。随访期内无一例发生死亡,治疗组及对照组分别有1例（4.2%）及8例（33.3%）发生心包缩窄。结论：留置中心静脉导管加尿激酶灌洗治疗急性结核性心包炎安全、可行,心包积液引流彻底,拔管时间早,心包膜增厚程度显著减轻,心包粘连机会减少,能有效地预防患者心包缩窄的发生。

Clinical observation of detained central venous catheter along with intrapericardial urokinase in treament of acute tuberculous pericarditis

Objective：We study the curative effect of detained central venous catheter along with intrapericardial urokinase in treament of acute tuberculous pericarditis.Methods：The patients diagnosed as acute tuberculous pericarditis with moderate to massive pericardial effusion（the disease course of all patients was less than 1 month）,28males and 20 females,aged from 14 to72 years,were consecutively recruited from January 1996 to May 2009.All individuals who received the same anti-tuberculosis chemotherapy and glucocorticoid,were randomized to detained central venous catheter along with intrapericardial urokinaset or detained central venous catheter.we observe and compare puncture-related complication（including arrhythmia,Intrapericardial hemorrhage and infection）,measuring pericardiac thickness before and after treatment,residual volume of pericardial effusion after extubation.the long-time complications depended on the telephone survey and echocardiographic examination.the deadline of follow-up was May 2010.the duration of following-up ranged from 11 to 132 months.Results：Compared with control group,there are significant difference of study group in pericardiac thickness,residual volume of pericardial effusion after extubation,the long-time complications（P0.05）.there is no difference in puncture-related complication between control group and study group（P0.05）.In study group,all patients occured intrapericardial bleeding and systemic bleeding after treatment with intrapericardial urokinase.In follow-up period,there was no death,and pericardial constriction events were observed in 1 and 8 cases in study（4.2%）and control group（33.3%）,respectively.Conclusion：Detained central venous catheter plus intrapericardial urokinase is safe and feasible,and promoted complete drainage of pericardial effusion,significantly reduced the thickness of pericardium,alleviated the adhesion and early removed catheter,and to prevent the development of pericardial constriction effectively.