这位患有心周溢血的病人有心脏吸管吗?
Christopher L Roy1, Melissa A Minor, M Alan Brookhart
1Division of General Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02115, USA. croy@partners.org
JAMA
|April 26, 2007
概括
临床检查可以帮助诊断心脏吸管,一种血液动力学妥协的条件. 像脉冲悖论这样的关键标志大于10毫米的帮助诊断,但往往需要进一步的测试以获得确定性.
科学领域:
- 心脏病学 心脏病学
- 内部医学 内部医学
- 紧急医疗 紧急医疗
背景情况:
- 心脏吸管是一种危及生命的疾病,由心周空间的液体积累引起,导致心脏压缩和血液动力学损害.
- 临床检查在识别可能受益于心周切割的患者中起着至关重要的作用,特别是当心声扫描证实了诊断时.
研究的目的:
- 系统地审查临床病史的诊断准确性,体检结果和心脏栓塞的基本诊断测试.
- 评估各种临床症状在诊断心脏栓塞时的可靠性.
主要方法:
- 针对1966年至2006年间出版的英语文章进行了全面的MEDLINE搜索,并补充了文章和教科书的参考列表.
- 包括的研究比较了临床检查方面与心脏吸管诊断的参考标准,每项研究至少有15名患者. 八项研究在选787个已识别的文章后满足了纳入标准.
- 数据提取和质量评估由两位作者独立进行,分歧由第三位审查员解决.
主要成果:
- 在心脏吸管患者中经常观察到五种临床特征:呼吸不全 (87%-89%的灵敏度),心动减速 (77%的综合灵敏度),脉冲悖论 (82%的综合灵敏度),关静脉压力升高 (76%的综合灵敏度) 和胸部X射线图上心血管大变 (89%的综合灵敏度).
- 脉冲悖论大于10mmHg的患有心周溢血的患者显著增加了坦波纳德的可能性 (概率比,3.3).
- 相反,脉冲悖论为10 mm Hg或更低的脉冲悖论显著降低了吸管的可能性 (概率比,0.03).
结论:
- 虽然呼吸不全,心动减速,关静脉压升高和心血管大病在心脏吸管中很常见,但少数患者可能不会表现出所有这些症状.
- 超过10mm Hg的脉冲悖论是区分心脏栓塞与心周溢出患者其他疾病的有价值指标.
- 为了达到心脏吸管的诊断确定性,需要在最初的临床评估之外进行进一步的调查.
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