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目的应用超声心动图评价缩窄性心包炎(CP)患者右室收缩功能,并探讨其预测患者心包剥脱术后心脏不良事件的价值。方法对36例行心包剥脱术的CP患者及32例正常对照组采用超声心动图测量右室面积变化率(RVFAC)、三尖瓣环位移(TAPSE)。CP患者心包剥脱术后随访是否发生心脏不良事件(充血性心力衰竭或心源性死亡)。结果与对照组相比,CP患者TAPSE及RVFAC较正常人显著减低,(P<0.05)。(2.8±1.7)年的随访后,CP患者中有7例(19%)发生不良事件(ACE组),其余29例(81%)未发生不良事件(NACE组)。ACE组TAPSE明显小于NACE组(P<0.05)。TAPSE是预测心包剥脱术后不良事件的敏感因子,阈值为17.5mm,灵敏度和特异度为87%及82%。结论 CP患者右室收缩功能减低,TAPSE可以预测心包剥脱术后是否发生心脏不良事件,为临床治疗方案的选择及预后评价提供可信赖的指标。
Objective To evaluate the right ventricular systolic function in patients with constrictive pericarditis (CP) by echocardiography and to explore the value of predicting cardiac adverse events after pericardial exfoliation in patients. Methods The RVFAC and TAPSE were measured by echocardiography in 36 CP patients with pericardial exfoliation and 32 normal controls. CP patients were followed up for cardiac adverse events (congestive heart failure or cardiac death) after percutaneous dissection. Results Compared with the control group, the TAPSE and RVFAC in CP patients were significantly lower than those in normal controls (P <0.05). After 2.8 ± 1.7 years of follow-up, 7 (19%) of CP patients developed adverse events (ACE group) and the remaining 29 patients (81%) had no adverse events (NACE group). TAPSE in ACE group was significantly lower than that in NACE group (P <0.05). TAPSE is a sensitive factor for prediction of adverse events after pericardial stripping, with a threshold of 17.5 mm and a sensitivity and specificity of 87% and 82%, respectively. Conclusions The right ventricular systolic function is reduced in patients with CP. TAPSE can predict the occurrence of adverse cardiac events after pericardial exfoliation and provide a reliable index for the selection of clinical treatment options and prognosis.