急性心包炎课件篇.pptx

Acute pericarditis急性心包炎曹泽龙指南的推荐程度和证据水平Ⅰ类：已证实和（或）一致公认某诊疗措施有益、有用和有效。Ⅱ类：某诊疗措施的有用性和有效性的证据尚有矛盾或存在不同观点。Ⅱa类：有关证据和（或）观点倾向于有用和有效。Ⅱb类：有关证据和（或）观点尚不能充分说明有用和有效。 Ⅲ类：已证实和（或）一致公认某诊疗措施无用和无效并在有些病例可能有害，不推荐应用。证据水平A：资料来源于多项随机临床试验或汇总分析。证据水平B：资料来源于单项随机临床试验或多项非随机试验。证据水平C：专家共识和（或）小型试验结果。病因AetiologyViruses： developed countriestuberculosis (TB)： developing countries， often associated with humanimmunode?ciency virus (HIV) infection诊断标准是一种炎症性心包综合征，可伴或不伴心包积液符合以下标准的两项即可诊断:1.胸痛（85–90%）：尖痛，坐位与前倾时improve 2. pericardial friction rub心包摩擦音≤33%：胸骨左缘较明显3.心电图变化up to 60%：广泛导联ST段抬高orPR段压低，心外膜炎症4. pericardial effusion心包积液up to 60%：generally mild常伴有炎症反应指标升高： C-reactive protein(CRP)、 erythrocyte sedimentation rate (ESR)、 white blood cell count；可判断病变活动情况及治疗效果Patients with concomitant myocarditis may present with an elevation （ [el?ve??(?)n]）of markers of myocardial injury [i.e. creatine kinase (CK), troponin]A chest X-ray is generally normal in patients with acute pericarditis since an increased cardiothoracic ratio（心胸比率） only occurs with pericardial effusions exceeding 300 mlDiagnosisManagement危险因素high fever：＞38Csubacute course (symptoms over several days without a clear-cut acute onset)large pericardial effusion (i.e. diastolic心脏舒张的echo-free space ＞20 mm)cardiac tamponade（心包填塞）failure to respond within 7 days to NSAIDs次要：Associated with myocarditis (myopericarditis)、immunodepression、trauma、oral anticoagulant抗凝 therapyTreatmentRestrict physical activity 普通人（until resolution of symptoms and normalization of CRP、 ECG and echocardiogram ）运动员[symptoms have resolved and diagnostic tests(i.e. CRP, ECG and echocardiogram) have been normalized]，至少3月Drugs：主要是aspirin or NSAIDsColchicine：?[‘k?lt??si?n] 秋水仙碱：辅助用药，提高治疗效果、预防复发，当上述治疗无效，且排除感染和自身免疫性疾病后可考虑小剂量应用糖皮质激素Treatmentbid.=twice daily; CRP =C-reactive protein=; Tx ?treatment.a：Tapering should be considered for aspirin and NSAIDs.b：Tx duration is symptoms and CRP guided but generally 1–2 weeks for uncomplicated cases. Gastroprotection should be provided. Colchicine is adde