Life-threatening conditions in pericarditis of different etiologies: diagnosis and treatment

A. Kosonogov, S. Nemirova, V. I. Pozdishev, A. B. Nikolskiy, K. A. Kosonogov, A. D. Ribinckiy, M. Sidorov, S. V. Loginova
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Abstract

Purpose of the study: to analyze the etiology, diagnostic criteria and results of treatment of life-threatening conditions in pericarditis of different etiologies (based on our clinic materials).Materials and methods. The study included cases of hospitalization of patients with a diagnosis of «Pericarditis» and ICD-10 codes for pericardial diseases for the period from 2009 to 2018. In the course of the work, the history and clinical picture of the disease, laboratory and radiation research methods were analyzed. All patients started treatment of the underlying disease and performed symptomatic therapy, including those aimed at restoring hemodynamics and normalizing water and electrolyte disorders, stopping inflammation and auto-aggression of the immune system. When signs of compression/cardiac tamponade were detected, pericardiocentesis was performed, according to indications, drainage/fenestration of the cardiac sac, pericardiotomy were performed. In the postoperative period was carried out antibacterial and symptomatic therapy.Results. Life-threatening diseases of the pericardium accounted for 32,03% of all patients treated in the hospital for pericarditis. The most frequently detected signs of a hemodynamically significant compression and cardiac tamponade, less often purulent and constrictive P. Isolated 25 patients underwent closed drainage with pericardiocentesis, in 1 case the drainage was supplemented with f ibrinolytic therapy. Sanitation of the cavity and fenestration of the pericardium were carried out in 11 patients, pericardiotomy with notched drainage in 2 patients, thoracotomy with pericardiectomy – 4. In the postoperative period, the symptoms of inflammation were reduced, the level of cardiac enzymes decreased, the electrolyte balance stabilized. Most patients noted a distinct regression of the symptoms of pericarditis and cardiac compression. Recurrent P was noted in 5 cases, deaths occurred in 4 cases (8,16%).Conclusion. Early verification of the diagnosis and timely decompression of the heart with fractional evacuation of the exudate or pericardectomy with respect to the sequence of release of the heart chambers from adhesions and adhesions against the background of complex therapy allows to achieve positive dynamics, and fenestration of the cardiac bag with the formation of a sufficiently sized opening during recurrent fluid accumulation or intrapericardial fibrin. development of severe complications of pericarditis even in patients with multiple concomitant diseases evanii and oncopathology.
不同病因的危及生命的心包炎:诊断和治疗
研究目的:分析不同病因的心包炎的病因、诊断标准和危及生命的治疗结果(根据我们的临床资料)。材料和方法。该研究包括2009年至2018年期间诊断为“心包炎”和ICD-10心包疾病代码的住院患者病例。在工作过程中,对本病的病史和临床表现、实验室和放射研究方法进行了分析。所有患者开始治疗基础疾病并进行对症治疗,包括旨在恢复血液动力学和正常化水和电解质紊乱,停止炎症和免疫系统自身攻击的治疗。当发现有压迫/心包填塞迹象时,行心包穿刺,根据指征,心囊引流/开窗,行心包切开术。术后进行抗菌及对症治疗。危及生命的心包炎疾病占医院治疗的心包炎患者总数的32,03%。最常见的是血流动力学上明显的压迫和心包填塞,较少见的是脓性和收缩性p。孤立25例患者行心包穿刺闭式引流,1例辅以溶纤治疗。对心包腔、开窗进行卫生处理11例,心包切开切口引流2例,开胸心包切开4例。术后炎症症状减轻,心肌酶水平下降,电解质平衡稳定。大多数患者心包炎和心脏受压症状明显减轻。P复发5例,死亡4例(8.16%)。诊断的早期验证和及时的心脏减压,部分排出渗出液或心包切除术,根据粘连和粘连的释放顺序,在复杂治疗的背景下,可以实现积极的动力学,并在反复积液或心包内纤维蛋白形成足够大的开口时打开心包。心包炎严重并发症的发展,即使是在多发性伴发疾病和肿瘤病理。
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