2023 年第 11 期 第 18 卷

慢性缩窄性心包炎患者心包剥脱术后近远期心脏舒张功能改善情况评估研究

Assessment study on short and longterm improvement of cardiac diastolic function in patients with chronic constrictive pericarditis after pericardiectomy

作者：尚基高蒙延海黄海波李露露李泽蒙张燕搏

英文作者：Shang Jigao Meng Yanhai Huang Haibo Li Lulu Li Zemeng Zhang Yanbo

单位：中国医学科学院阜外医院外科重症监护室，北京100037

英文单位：Department of Surgical Intensive Care Unit Fuwai Hospital Chinese Academy of Medical Sciences Beijing 100037 China

关键词：慢性缩窄性心包炎；心包剥脱术；经胸超声心动图；心脏舒张功能

英文关键词：Chronicconstrictivepericarditis;Pericardiectomy;Transthoracicechocardiography;Cardiacdiastolicfunction

• 摘要：

• 目的    应用组织多普勒超声成像技术获得二尖瓣环舒张早期最大血流速度（e′），以评估慢性缩窄性心包炎（CCP）患者心包剥脱术后近远期心脏舒张功能改善情况。方法  选择2021年1月至2022年12月因CCP在中国医学科学院阜外医院行心包剥脱手术，并且术后收治于外科重症监护室的25例患者作为研究对象进行回顾性队列研究。收集患者基本资料、术中资料、术后资料和围手术期超声检查结果加以分析。结果  25例患者年龄（43±16）岁，其中男15例、女10例，体重指数（21±4）kg/m2，CCP病程16（9,48）个月。25例患者均行完全心包剥脱术。术后1周、术后3个月时室间隔e′小于术前1周，二尖瓣舒张早期最大血流速度/e′比值大于术前1周［（9.8±0.7）、（8.8±2.5）cm/s比（13.2±4.4）cm/s，（9.8±2.7）、（9.8±4.0）比（6.3±2.4）］，差异均有统计学意义（均P<0.05）。术前1周、术后1周、术后3个月侧壁e′分别为（13±5）、（14±5）、（12±4）cm/s，差异无统计学意义（P>0.05）。结论  心包剥脱术后早期开始室间隔e′即已出现持续下降趋势，室间隔e′/侧壁e′比值逐渐反转为正常的规律，借此可及时有效评估患者术后心脏舒张功能恢复情况，为患者术后早期和远期治疗及随访方案的制定提供参考。

• Objective  To evaluate the short and longterm improvement of cardiac diastolic function by early diastolic maximum blood flow velocity of mitral annulus(e′)obtained by tissue Doppler ultrasound imaging in patients with chronic constrictive pericarditis(CCP) after pericardiectomy. Methods  From January 2021 to December 2022, 25 patients who underwent pericardiectomy in Fuwai Hospital, Chinese Academy of Medical Sciences and were admitted to the Department of Surgical Intensive Care Unit after surgery were selected as the research subjects for retrospective cohort study. The basic data, intraoperative data, postoperative data and perioperative ultrasound Results   of patients were collected and analyzed. Results  Twenty-five patients were aged (43±16) years, including 15 males and 10 females, with a body mass index of (21±4)kg/m2 and a CCP course of 16(9,48)months. All 25 patients underwent complete pericardiectomy. At 1 week and 3 months after surgery, the interventricular septum e′ was smaller than that 1 week before surgery, and the early diastolic maximum blood flow velocity of mitral valve/e′ ratio was greater than that 1 week before surgery［(9.8±0.7), (8.8±2.5)cm/s vs (13.2±4.4)cm/s; (9.8±2.7), (9.8±4.0) vs (6.3±2.4)］(all P<0.05). The lateral wall e′ at 1 week before surgery, 1 week after surgery, and 3 months after surgery were respectively(13±5), (14±5), and (12±4)cm/s(P>0.05). Conclusions    Since the early stage after pericardiectomy, the ventricular septum e′ shows a continuous downward trend, and the ratio of ventricular septum to lateral wall e′ gradually reverses to a normal pattern. It can be used to evaluate the recovery of postoperative cardiac diastolic function in a timely and effective manner, provide reference for early and long-term treatment and follow-up plan.