Objective To explore the perioperative management of 46 patients with chronic constrictive pericarditis. Methods The clinical data of 46 patients admitted to the Cardiac Surgery Department of the General Hospital of Chinese PLA from May 2005 to April 2011 were retrospectively analyzed. The cases included 37 males and 9 females, with a mean age of 45 years (range 11 to 71). A total of 11 patients were preoperatively classified into New York Heart Association (NYHA) functional class Ⅱ, 30 into class SI, and 5 to class IV. Echocardiography and mediastinal CT scan were used to diagnose constrictive pericarditis. All patients were subjected to pericardiectomy via median sternotomy under general anesthesia. Two patients underwent atrial septal defect repair. One patient underwent simultaneous coronary artery bypass grafting. The atria and ventricles were measured before and after the operation via echocardiography. Central venous pressure (CVP) was also measured through the femoral vein before operation, and CVP was dynamically monitored through the jugular vein during and after operation. Results No patient died after the operation. Complications developed in nine cases, including one case of bleeding after surgery, six cases of low cardiac output syndrome, one case of respiratory failure Ⅱ, and one case of gastrointestinal hemorrhage. All the patients left the hospital well after treatment. Echocardiography showed that the size of the left atria decreased (P=0.00l), whereas that of the left and right ventricles increased (P=0.002 and P=0.030, respectively) after the operation. CVP lowered after the operation (P=0.000). All patients were followed up from 4 months to 6 years after the operation and were found to have improved heart function. A total of 40 patients were classified as class I and 6 as class Ⅱ. Abdominal distention and chest distress disappeared after operation. Conclusion Proper perioperative management and pericardiectomy can improve the heart function of patients with chronic constrictive pericarditis.%目的 探讨缩窄性心包炎的围术期处理方法.方法 回顾性分析2005年5月—2011年4月解放军总医院心外科收治的46例缩窄性心包炎患者的临床资料,其中男37例,女9例.年龄11～71岁,平均45岁,术前心功能(NYHA 分级)Ⅱ级11例,Ⅲ级30例,Ⅳ级5例.所有患者术前行超声心动图及纵隔CT以确诊.46例患者均于全麻下经胸部正中切口行心包剥脱术,同期行房间隔缺损修补术2例,冠状动脉旁路移植术1例.手术前后行心脏超声测量各心房、心室腔大小.手术前经股静脉测量中心静脉压(CVP),术中及术后经颈静脉动态监测CVP.结果 本组患者无围术期死亡.术后二次开胸止血1例,出现低心排综合征6例,Ⅱ型呼吸衰竭1例,消化道出血1例,均治愈后出院.心脏超声示术后左房内径(LA)较术前明显减小(P=0.001),左室内径(LV)、右室内径(RV)较术前增加(P=0.002,P=0.030),CVP较术前下降(P=0.000).术后随访4个月～6年,所有患者腹胀、胸闷症状消失,心功能Ⅰ级40例,Ⅱ级6例.结论 正确的围术期处理及充分合理的心包剥脱,可使缩窄性心包炎患者术后心功能明显改善.
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