現代における狭窄性心膜炎:臨床スペクトルの進化と,心膜切除術後の結果への影響
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minn, USA.
Circulation
|September 29, 1999
まとめ
狭窄性心膜炎 (CP) の表情は変化し,高齢の患者と放射線誘発症例が増加しています. 循環器切除術の結果は,特に放射線誘発性心筋梗塞の場合は影響を受けますが,手術はほとんどの生存者の症状を改善します.
科学分野:
- 心臓病学 心臓病学
- 胸部外科手術について
- 医学的な成果 研究研究
背景:
- 狭窄性心膜炎 (CP) の病因要因が進化し,臨床表現と治療結果に影響を及ぼしています.
- CPの発生率の変化は,外科介入の有効性の再評価を必要とします.
研究 の 目的:
- 結束性心周炎 (CP) の病因因子の変化が心周切除術の結果に与える影響を評価する.
- 現代のCP患者の人口統計とアウトカムを,過去のデータと比較する.
主な方法:
- 135人の現代 (1985年−1995年) のコンストリクティブ・ペリカルディティス (CP) 患者と歴史的なコホートとの遡及的比較.
- 術後の死亡率,生存期末,心筋切除術後の機能状態の分析.
- 段階的なロジスティック回帰は,長期的な結果の独立した予測要因を特定します.
主要な成果:
- 当時のCP患者は高齢 (平均61歳対45歳) であり,心臓外科手術と中枢内放射線治療による発症率が増加した.
- 術後の死亡率は著しく減少した (6% vs. 14%),しかし,10年後の生存率は一般人口 (57+/-8%) よりも劣っていた.
- 年齢,NYHAクラス,および後放射線は,独立して予測された長期的な結果を引き起こします; 83%の生存者が症状の改善を報告しました.
結論:
- 高齢患者および放射線誘発性疾患を含むコンストリクティブ心周炎 (CP) の進化するプロファイルは,心周切除術の予後に影響を及ぼします.
- 循環器切除術の長期的結果は,特定のグループ,特に放射線誘発性心筋梗塞の患者にとって最適ではない.
- 課題があるにもかかわらず,ペリカードクトミーは,長期間生存者の大半の症状を緩和または改善します.
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