摘要：
目的 通过对儿童大量心包积液的病因诊断及治疗预后进行回顾性分析,探讨超声心动图检查在儿童大量心包积液诊断及随访中的应用价值.方法 回顾性分析2010年3月至2016年3月于首都医科大学附属北京儿童医院确诊的68例儿童大量心包积液的病历资料,对其病因、预后、心包积液性质及超声心动图特征进行总结分析.结果 本组患儿大量心包积液病因诊断率约为97.1％(66/68例),治疗有效率约为71.8％(46/64例),病死率约为7.8％(5/64例),4例失访.发病率由高到低依次为感染性心包积液27例,肿瘤相关心包积液14例,心脏手术及外伤14例,全身系统性疾病6例,淋巴管相关疾病5例及特发性心包积液2例.肿瘤相关心包积液及淋巴管疾病所致大量心包积液的治疗有效率显著低于总有效率,差异均有统计学意义(28.6％比71.8％,x2=9.092,P=0.003;20.0％比71.8％,x2 =5.059,P=0.018).35例患儿行心包穿刺或开窗引流,乳糜性心包积液仅见于淋巴管相关疾病.肿瘤相关心包积液均为血性心包积液.超声心动图显示心包腔内的强回声光点对血性心包积液有提示作用(x2=5.166,P=0.023).超声心动图探查到心包腔内异常团块回声时需考虑肿瘤或感染所致心包积液.结论 儿童大量心包积液多有明确病因,超声心动图检查是诊断儿童大量心包积液的首选方法,结合临床表现及超声心动图特点有助于病因分析.%Objective To investigate the value of echocardiography application in the diagnosis of large amount of pericardial effusion (PE) in children by retrospective etiology and prognostic analysis.Methods A total of 68 children with large amount of PE admitted in Beijing Children's Hospital,Capital Medical University from March 2010 to March 2016 were reviewed retrospectively,and the echocardiographic presentations,etiology diagnosis,treatment,and prognosis were analyzed.Results Analysis indicated that the etiology diagnosis ratio was 97.1％ (66/68 cases),the effective ratio of the medical treatment was 71.8％ (46/64 cases),and the mortality rate was 7.8％ (5/64 cases).The morbidity was ranked from high to low as follow:large amount of PE included infectious pericarditis 27 cases,tumor associated PE 14 cases,postpericardiotomy syndrome and cardiotrauma 14 cases,systemic diseases 6 cases,vasa lymphatic related diseases 5 cases and idiopathic PE 2 cases.PE resulted from tumor associated PE and vasa lymphatic diseases had lower cure rate than the overall cure rate,and there were statistical significance (28.6％ vs.71.8％,x2 =9.092,P =0.003;20.0％ vs.71.8％,x2 =5.059,P =0.018).Thirty-five children received pericardiocentesis or fenestration drainage.Chylopericardium was restricted to vasa lymphatic diseases.All tumor associated PE had the hemorrhagic PE.The strong echo point in the pericardial cavity might indicate implication for hemorrhagic PE (x2 =5.166,P =0.023).The abnormal mass detected by echocardiography might indicate the tumor related or infectious causes.Conclusions The etiology of large amount of PE could be determined in most of children.As the preferred diagnosis method,echocardiography could help etiological diagnosis combined with clinical manifestation.
