持続心嚢ドレナージが著効を示した若年の化膿性心外膜炎

Effectiyity of Continuous Pericardial Drainage for Purulent Pericardiatitis: Acase report

　若年の化膿性心外膜炎の1例を報告する．症例は28歳，男性，主訴は意識消失．1995年6月23日，心肺停止状態で救急車で緊急入院した．胸部X線写真，心エコーより心タンポナーデと診断，心嚢穿刺で淡黄色に混濁した心嚢水を吸引した．その後心嚢液の再貯留を認めたため再度心嚢穿刺を行い持続ドレナージを行った．全身状態は改善し，救命し得た．化膿性心外膜炎は予防医学の浸透と抗生物質の発達により稀な疾患となっており，その発症も基礎疾患を有している場合が多い．本例は健康な成人男性であり稀な症例と考えられる．また，治療は抗生剤の投与と心嚢穿刺であるが，それだけでは不十分な場合，外科手術，あるいは持続心嚢ドレナージが有効である．

A 28-year-old man was admitted to our hospital because of loss of consciousness on June 23, 1996. He had suffered heart arrest, and resuscitation was begun imme-diately. A chest roentgenogram showed no air in the right lung and enlargement of cardiac silhouette. An echocardiogram demonstrated a massive pericardial effusion. The diagnosis was cardiac tamponade, and he underwent subxiphyoid pericardiotomy with drainage of 1000 ml of purulent material. Though intervenous ceftazidime and clindamycin was prescribed, 1 week later continuous pericardial drainage was necessary because of the great increase of the pericardial effusion. He remained hemodvnamically stable under this regi-men. Since the spread of prophylactic medicine and the advance of antibiotic therapy, pericardiatitis has become uncommon. Most of the recent cases have funda-mental disease, and there are very few cases such as was found in some this young healthy man. Antibiotic ther-apy or subxiphyoid pericardiotomy are effective as a method of treatment, but operation or continuous drain-age are necessary when they are not effective enough.