Purulent Pericarditis: Reports 5 Cases

化膿性心包膜炎之診斷與治療：五病例報告

林仙明(Sin-Ming Lam) ； 顧博明(Po-Ming Ku) ； 黃崔源(Tsuei-Yuen Huang)

《中華民國急救加護醫學會雜誌》 8卷3期 (1997/09) Pp. 133-138

https://doi.org/10.30018/JECCM.199709.0007

摘要

自1980至1996年間，回顧台南奇美醫院化膿性心包膜炎病例共有五位。五病例中，有三例分離出革蘭氏陰性細菌，而二例屬金黃色葡萄球菌，其中三例為男性，平均養病年齡為60歲（年齡範圍從41至74歲）。要得到正確的臨床診斷（化膿性心包膜炎），所需平均時間約10天（時間範圍從1天至26天）。五例中有四例經治療後存活，唯一死亡病例是經成功地以心包膜引流術合併適當抗生素治療後，心包膜炎獲得改善，最後死於無法控制的上消化道食道靜脈瘤出血。本文提出結論是若早期診斷及適當抗生素治療且合併心包膜引流治療是決定化膿性心包膜炎患者存活率的主要因素。另外病人的潛在內科疾病亦是決定存活率的主要因素之一而致病菌與早期文獻所提出的報告大不相同。革蘭氏陰性細菌如Klebsiella pneumonia,Acinetobacter baumannii及Serratia marcescens等卻變為重要的致病菌。

關鍵字

化膿性心包膜炎

並列摘要

In a review of 5 patients with purulent pericarditis, gram-negative bacilli were isolated in 3 cases, and Staphylococcus aureus was isolated in the remaining 2 cases. Three patients were male, and the the mean age was 60 years old (range 41 to 74 years). The average time to arrive at a clinical diagnosis of purulent pericarditis was 10 days (range 1 day to 26 days). While 4 of the 5 patients survived, one patient died of massive gastrointestinal bleeding due to esophageal varices after successful surgical treatment of the purulent pericarditis. We suggest that early diagnosis and appropriate antibiotics treatment combined with pericardial drainage are the determinating factors of good results. The offending organisms in this small series are quite different from other reports which found gram-negative bacilli such as Klebsiella pneumonia, Acinetobacter baumannii, and Serratia marcescens.

並列關鍵字

purulent pericarditis