急性心包炎PPT课件

Acute pericarditis
急性心包炎
曹泽龙
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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。
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• 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。
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Treatment
• Restrict 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 NSAIDs • Colchicine： [‘kɒltʃɪsiːn] 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
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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
Diagnosis
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Management
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危险因素
• high fever：＞38C • subacute 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 therapy

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Aetiology
• Viruses： developed countries • tuberculosis (TB)： developing countries， often associated with humanimmunodeficiency virus (HIV) infection
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Treatment
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• bid.=twice daily; CRP =C-reactive protein=; Tx ¼ 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 added on top of aspirin or ibuprofen.症状缓解及CRP正常后减量
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• 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 （ [elɪ'veɪʃ(ə)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 ml