収縮性心膜炎手術の術後早期予後の検討

Early Operative Result of Pericardiectomy for Constrictive Pericarditis

　収縮性心膜炎（CP）手術の術後早期予後を検討した．対象は14例で，原疾患は原因不明6例，結核性3例（活動期2例），中皮腫2例（悪性1例）で，開心術後，慢性透析に起因するもの，膠原病が各1例であった．手術に耐えた13例を軽快群（n＝6）と非軽快群（n＝7）に分け，血行動態，術前因子（患者因子，血液生化学検査，血行動態）で比較し，更に，人工心肺使用の有無，非軽快群での患者背景，術前のC反応性蛋白（CRP）値と中心静脈圧（CVP）の相関について検討し以下の結果を得た．1）軽快群では術直後の改善をそのまま維持したが，非軽快群では退院時にCVPが有意に再上昇した．2）心嚢液貯留は非軽快群のみでみられ，CRP値が非軽快群で有意に高値であった．3）CPの病因や術前の心膜炎の遷延や再燃が術後早期予後に関連した．つまり，抗炎症を十分に念頭に置いた早期の心膜切除術が好ましいと思われた．

　Early operative results of pericardiectomy for constrictive pericarditis was studied. Fourteen patients were studied. They consisted of 6 of unknown etiology, 3 with tuberculosis, 2 with mesothelioma, and 1 each ofpost cardiac surgery, chronic renal failure and collagen disease. The 13 patients who survived were divided into improved (n=6) and not-improved groups (n=7). Hemodynamic changes and preoperative factors (patient-related factors and laboratory data) in these 2 groups were compared. The influence of cardiopulmonary bypass was also evaluated. The immediate postoperative relief was maintained in the improved group, but central venous pressure (CVP) was re-elevated at discharge in the not-improved group. Pericardial effusion and elevation of CRP level were found only in the not-improved group. The usefulness of cardiopulmonary bypass in the early stage was not able to be clarified. The etiology of the diseases involved and preoperative inflammation due to pericarditis influenced the early postoperative result. Therefore, early pericardiectomy should be accompanied by considerable use of anti-inflammatory regimens.