感染性心内膜炎INFECTIVE ENDOCARDITIS

感染性心内膜炎INFECTIVEENDOCARDITIS概述概念微生物感染赘生物形成受累部位瓣膜间隔缺损部位腱索心壁内膜分类急性（数天）亚急性（数周至数月）自体瓣膜人工瓣膜静脉药瘾者OutlinesConception

Infectionofmicrobes,ecphymaformationSitesinvolvedValves,septaldefects,chordatendineaeCategorizationsAcute,subacuteAllovalves,prostheticvalve病因细菌感染为主急性金黄色葡萄球菌亚急性草绿色链球菌菌谱复杂真菌衣原体少见

静脉药物滥用者金黄色葡萄球菌50%

人工瓣膜凝固酶阴性葡萄球菌金黄色葡萄球菌革兰氏阴性杆菌EtiologyBacterialinfection

Acute:

StaphylococcusaureusSubacute:StreptococcusviridansandothersRarelycausedbyeumyceteorchlamydiainfection

Intravenousdrugabusers:halfwerecausedbystaphylococcusaureusProstheticvalvepatients:Staphylococcusaureus,Gram-Negativebacillus发病机制血流动力学因素亚急性多见于器质性心脏病赘生物位于血流从高压腔到低压腔形成湍流和射流的下游高速射流冲击心脏或大血管内膜处并致损伤感染性心内膜炎内面观—赘生物MR时二尖瓣心房面AR时主动脉瓣心室面PathogenesyAbnormalhaemodynamicsOrganicheartdiseaseHighspeedafflux发病机制典型的非细菌性血栓性心内膜炎非细菌性血栓性心内膜炎非细菌性血栓性心内膜炎内皮受损高凝状态赘生物很少超过0.5cmPathogenesy典型的非细菌性血栓性心内膜炎非细菌性血栓性心内膜炎Non-bacterialembolicendocarditisEndothelialdamageHypercoagulabalestateEcphyma<0.5cm发病机制非细菌性血栓性心内膜炎非细菌性血栓性心内膜炎SLE患者扁平状赘生物附于瓣膜及腱索，心内膜急性风湿热疣状赘生物附于瓣膜闭合处边缘非细菌性血栓性心内膜炎Non-bacterialembolicendocarditisSLEpatients

Acuterheumaticfever

Pathogenesy发病机制短暂性菌血症皮肤粘膜内外科、牙科操作人工瓣膜置换术注射毒品细菌感染无菌性赘生物

细菌数量毒力侵袭力粘附力急性感染性心内膜炎机制不清正常瓣膜金黄色葡萄球菌PathogenesyTransientbacteremiaSkin,mucosaoperation

Prostheticvalvereplacement,DruginjectionBacterialinfectedecphyma

Bacterialnumber,toxicity,invasiveness,adhersionAcuteendocarditis

Unclearmechanism,normalvalves,Staphylococcus

aureus发病机制静脉内药物滥用者右心室入口—三尖瓣人工瓣膜术后第一年人工主动脉瓣人工二尖瓣机械瓣生物猪瓣PathogenesisIntravenousdrugabuser

Rightventricle—tricuspidProsthetic

valve

Oneyearafteroperation

Aorticvalveprosthesis,mitralvalveprosthesis

Mechanicalprostheticvalve,biologicalvalve病理心内感染赘生物结节状菜花状息肉状感染性心内膜炎

主动脉瓣上有一红棕色的赘生物PathologyEndocardiainfection

Ecphyma

nodosity

cauliflower

polyiformInfectiveendocarditis

Marronecphymacanbefoundinaorticvalve病理心内感染瓣叶破损穿孔腱索断裂感染性心内膜炎不规则的红棕色赘生物位于主动脉瓣瓣尖并造成损害PathologyEndocardiainfectionValveleafledamagedRuptureofchordae

tendinInfectiveendocarditisIrregularmarronecphymacanbefoundinaorticvalve病理感染性心内膜炎从二尖瓣扩散至室间隔及三尖瓣并形成瘘管局部扩散瓣环—乳头肌—心肌—传导系统—心包PathologyInfectiveendocarditisFistulafrommitralvalvetointerventricularseptumandtricuspidLocaldiffusionValvering—Columna

papillares—Myocardium—Conductingsystem—Pericardium病理赘生物脱落导致栓塞组织器官梗死脓肿动脉壁坏死动脉瘤PathologyEcphymashedding

embolisminfarction

abscessaneurysm病理血源性播散

菌血症迁移性脓肿免疫系统激活

脾肿大肾小球肾炎各种免疫性炎症

PathologyBlooddisseminateion

Bacteremia,immigratedabscessImmunesystemactivation

Enlargedspleen,glomerularnephritis,immuneinflammation

临床表现全身感染的表现

发热

急性高热亚急性弛张热器官功能衰竭非特异性脾肿大贫血一般表现乏力厌食关节肌肉痛ClinicalmanifestationGeneralinfection

Fever

Acute,hyperpyrexia

Subacute,remittentfever

Organ

dysfunction

Non-specificity,enlargedspleen,anemiaGeneralmanifestation:debilitation,anorexy,arthro-courbature

临床表现原有心脏病的表现

80~85%

心脏杂音变化外周表现

50%

瘀点瘀斑

线形出血Osler结节Janeway结节Roth点赘生物脱落的表现

20~40%

机体任何部位的栓塞Clinical

manifestationCardiopathicmanifestation

80~85%

Cardiacmurmur

variationPeripherymanifestation:50%

Petechia,filatehemorrhage,Oslernodus,Janeway

nodus,RothpointManifestationof

ecphyma

amotion:20~40%Embolism临床表现瘀点非特异肢端皮肤、粘膜、球结膜ClinicalmanifestationPetechia

Non-specific,in

acro-skin,mucosaandbulbarconjunctiva临床表现线状出血ClinicalmanifestationLinearhemorrhage临床表现Janeway

结节

小型红斑无压痛位于手掌、足底Clinical

manifestationJaneway

odus

Smallerythema

Absenceoftenderness

Inpalmandthenar临床表现Osler结节指趾的肉质部位小而柔软无特征性Clinical

manifestationOslernodus

Digital

ending

Smallandtender

Irremarkable并发症心脏心力衰竭急性心梗心肌脓肿化脓性心包炎心肌炎动脉瘤亚急性迁移性脓肿脾脏脓肿急性神经系统

脑卒中脑动脉瘤脑脓肿脑膜炎肾脏免疫复合物性肾小球肾炎肾功能不全ComplicationHeartHeartfailure,AMI,myocardialabscess,empyemaofpericardium,myocarditisAneurysmMigratedabscess,spleenabscess,NervoussystemStroke,brainaneurysm,brainabscess,meningitisKidney:immunecomplexglomerulonephritis,renalinadequacy实验室检查血液检查血培养每小时抽血一次共三次贫血白细胞血小板血沉（55mm/h)

免疫复合物和补体类风湿因子免疫球蛋白定量冷球蛋白C反应蛋白尿液检查血尿蛋白尿X线检查LaboratoryexaminationBloodexaminationHemoculture,haemospasiaonceanhour

anemia,bloodsedimentation（55mm/h)

immunocomplex,complemen,rheumatoidfactor,immuneglobulin,CRPUronoscopy

hematuria,

proteinuria

X-ray实验室检查超声心动图赘生物敏感性特异性瓣膜周围感染的扩大心肌脓肿

TTE28%98%TEE87%95%

赘生物大小、范围、活动度直径大于10mmLaboratoryexaminationEchocardiogram

ecphyma

peripheryinfectionofvalves

myocardialabscessTTE28%98%TEE87%95%诊断临床表现血培养阳性既往心脏病赘生物杂音的改变鉴别诊断亚急性风湿热SLE左房粘液瘤急性败血症Duke诊断标准

2主要标准1主要标准+3次要标准

5次要标准DiagnosisClinicalmanifestation:positivehemoculture,

heatdiseasehistory,

changingmurmurof

ecphymaDifferentialdiagnosis

Subacute:rheumaticfever,SLE,leftatrial

myoxomaAcute:septicaemiaDukediagnosticcriteria

2majorcriteria

1majorcriteria+3minorcriteria

5minorcriteria诊断DUKE诊断标准

主要标准血培养两次阳性心内膜受累依据超声心动图发现赘生物瓣膜结构改变新的瓣膜反流次要标准基础心脏病疾病或静脉药物滥用发热>38°C血管表现免疫学反应细菌学依据超声心动图提示21+35诊断DUKE诊断标准

MajorcriteriaPositivehemoculturetwiceEndocardiumdamage

Echocardiogram:

ecphyma

valvedamagenewly

valvularregurgitationMinorcriteriaHeartdiseasehistoryorintravenousdrugabuseTemperature>38°CAngio-manifestationImmunereactionBacterialinfectionHintfromEchocardiogram21+35治疗抗生素的治疗

用药原则：早期、充分、静脉用药、根据药敏试验选用药物病原体不明急性金黄色葡萄球菌亚急性链球菌已知病原体针对用药方案青霉素半合成青霉素+氨基糖甙类TreatmentAntibiotictreatment

Medicationprinciples：early、sufficient、intravenous、basisonsusceptibilitytestUnclearpathogen:

Acute--Staphylococcusaureus

Subacute--streptococcusClearpathogen:directmedicationScheme:

penicilin,semisyntheticpenicillin+aminoglycosides治疗并发症的治疗外科治疗赘生物的摘除10mm

瓣环脓肿反复复发血培养持续阳性瓣膜严重反流致心力衰竭真菌性心内膜炎TreatmentComplicationsSurgicaltherapy

excrescentextration,10mm

valveringabscess

relapserepeatedly,persistentpositive

hemoculture

valvularregurgitationinducedheartfailure

fungalendocarditis预防保持良好的口腔卫生预防性应用抗生素

患者的危险分层高危患者人工瓣膜既往IE病史发绀性先心心脏手术伴血流动力学异常中危患者二脱伴反流老年人退行性心脏病低危或无危险患者二脱无反流房缺原有心脏手术PreventionKeeporalhealthAntibioticsRisklevelsHighrisk:prostheticvalve,

IEhistory,

cyanosiscongenitalheartdisease,heartsurgerywith

abnormal

hemodynamicsModeraterisk:

mitral

prolapsewithcontraflow,retrogressionheartdiseaseLowrisk:mitral

prolapsewithnocontraflow,ASD预防手术操作的分类会引起牙龈或粘膜出血的口腔操作扁桃体摘除术胃肠道手术胆囊手术尿道手术阴道子宫切除术PreventionCarefuloperationprocedureStomato-operationTonsilsextrationGastrointestinaloperationOperationongallbladderOperationonurethraColpohysterectomy

预后未治疗的患者急性4周亚急性超过6月近期及远期预后心力衰竭肾功能衰竭栓塞革兰氏阴性杆菌和真菌心肌脓肿PrognosisUntreatedpatientsAcute4weeks

Subacutemorethan6monthsNearandlong-termprognosis

Heartfailure,renalfailure,embolism

Gram-Negativebacillusandeumycete:myocardialabscess心包疾病PERICARDIALDISEASE概述心包的正常功能心脏在胸腔内的固定减少心脏与周围组织的摩擦阻止炎症和肿瘤向心脏播散限制心脏的急性扩张OutlinePericardialfunctionHeart

fixationReduce

frictionbetweenheartandperipherytissuePreventheart

disseminateionofinflammationandtumorConstraintheartacutedilatation心包炎（pericarditis）最常见的心包病变全身疾病表现之一由邻近组织病变蔓延而来分期急性期6周以内亚急性期6周至6月慢性期6月以上心包炎（pericarditis）MostfrequentlyhappenedManifestationofgeneraldiseaseSpreadfromtissueinvicinityStagesAcuteLessthan6weeksSubacute6weeksto6monthsChronicMorethan6months急性心包炎（acutepericarditis）心包脏层和壁层急性炎症以胸痛、心包摩擦音和心电图改变为特征的综合征可同时合并心肌炎和心内膜炎急性心包炎（acutepericarditis）AcuteinflammationofepicardialandparietallayerofpericardiumAsyndromewithchestpain,pericardialfrictionrubandECGchangesCombinedwith

myocarditisandendocarditis病因感染性心包炎非感染性心包炎自体免疫性或过敏性急性非特异性、肿瘤性、急性心肌梗死性、尿毒症性、放射损伤性、邻近器官引起过敏性、风湿性疾病、药物性、创伤性结核性、细菌性、病毒性、真菌性、其他

EtiologyInfectiouspericarditisNon-infectiouspericarditisAutoimmunityandhyper-sensibilityacutenon-specificity,tumor,AMI,uremia,radiationinjuryHypersensibility,rheumatism,medicine,traumaticocclusionTuberculosis,bacterium,virus,eumyceteandothers病理急性纤维蛋白性心包炎（干性）

渗出性心包炎（湿性）纤维蛋白、白细胞和内皮细胞液体明显增多浆液纤维蛋白性浆液血性出血性化脓性渗液PathologyAcutefibrinouspericarditis

PericarditiswitheffusionFibrin,leucocyteandendotheliocyteFluid

Fibrinserosity

Blood

serosity

Hemorrhagic

Maturate病理纤维素性心包炎形态纤维蛋白的沉积物淡红色线状黄色渗出液见于尿毒症、急性心肌梗塞、急性风湿性心脏炎PathologyFibrinouspericarditisFibrinsedimentumsalmonpinklinearYelloweffusionInuremia,AMI,acuterheumaticcarditispatients病理浆液性心包炎形态未见纤维蛋白渗出物黄色渗出液炎性细胞液体中心脏表面以积液为主，少数情况下可引起心包填塞PathologyPericarditiswitheffusionNofibrineffusionYelloweffusionInflammationcellseffusionheartPericardialtamponade病理粘连性心包炎

从心外膜表面直到心包可见细小的纤维素性渗出物的沉积物，这是纤维素性心包炎的典型表现

PathologyAdhesivepericarditisCelluloseeffusioncanbefoundfromepicardiumtopericardium,itistypicalfibrinouspericarditis病理急性纤维素性心包炎心包膜表面粗糙，干燥，由此产生心包摩擦音见于尿毒症、急性心肌梗死、急性风湿性心脏炎PathologyAcutefibrinouspericarditisThesurfaceofcardiacpericardiumiscrudeanddry,pericardialfrictionrubcanbeheardPericardialfrictionrubInuremia,AMI,acuterheumaticcarditispatients病理出血性心包炎出血性心包炎的心脏外观呈红色，表面粗糙大多由转移性肿瘤和结核引起，结核还可引起肉芽肿性心包炎从而导致心包钙化，最终发展成缩窄性心包炎PathologyHemorrhagicpericarditisRedandroughMainlycausedbytumorandtuberculosis,granulomacanbeinducedbytuberculosis，constrictivepericarditiscanbedevelopedatlast病理化脓性心包炎可见黄色渗出物积于心包腔的低处PathologyPyopericarditisYelloweffusionaccumulateatthelowplaceofcavitaspericardialis病理生理心包积液心包腔压力上升心搏出量减少舒张期充盈减少动脉血压下降静脉压增高收缩力增强心率增快代偿PathophysiologyHydropericardiumCavitaspericardialispressureCardiacoutputDiastolicfillingArterialbloodpressureIncreasedvenouspulsepressure,fasterheartrateCompensation临床表现：症状全身症状

与病因相关心前区疼痛

纤维蛋白性阶段主要症状疼痛剧烈与体位有关

心包积液压迫症状呼吸困难咳嗽声音嘶哑吞咽困难心脏压塞严重呼吸困难急性循环衰竭和休克Clinicalmanifestation:symptomGeneralsymptomRelatedwithprimarydiseasePrecordialgiaMainsymptominfibriousstage

SeverepainRelatedwithbodyposition

Oppressionsymptoms

dyspnea

cough

hoarsevoice

dysphagiaCardiactamponade

Severedyspnea

Acutecirculatoryfailureandshock临床表现：体征心包摩擦音搔刮样，粗糙，高频，与心音无关胸骨左缘第三、四肋间最明显深吸气、坐位前倾时增强积液量增多时，减弱或消失急性纤维蛋白性心包炎的典型体征临床表现：体征心包积液体征

心尖搏动减弱或消失心浊音界向两侧扩大，心音低而遥远心包叩击音（pericardialknock）Ewart征心包填塞体征心动过速颈静脉怒张Kussmaul征奇脉

体循环淤血Clinicalmanifestation：physicalsignSignofhydropericardium

ApexbeatattenuatedordisappearedEnlargedcardiacdullness,lowheartsoundPericardialknockEwartsignSignofpericardialtamponadeCardiactachycardiaJugularvaricosity

Kussmaulsign

Paradoxicalpulse

Congestionofsystemiccirculation实验室检查

生化检查无特异性感染性心包炎常有白细胞计数中性粒细胞明显升高、血沉加快X线检查心影呈水滴状或烧瓶状透视下心脏搏动减弱或消失肺部无明显充血而心影显著增大有助于肺结核或肿瘤性心包炎的诊断Laboratoryexamination

BiochemistryNon-specificityIncreaselencocyte,neutrophilcountandESRX-rayDropwiseorflask-likeheartshadowHeartbeatattenuatedordisappearedEnlarged

heartshadowHelpfulinthediagnosisofpulmonarytuberculosisandneoplastiepericarditisX-ray心电图ST段呈弓背向下抬高伴T波动态改变肢导联QRS波群低电压P、QRS、T波电交替P-R段压低心律失常窦性心动过速房早、房速、房扑或房颤、房室传导阻滞ECGSTelevationanddynamicTwavealterationLow-voltageQRSP、QRS、TwaveelectricalalternationsP-RdepressionCardiacarrhythmiaSinustachycardia

Atrialprematurebeat,atrialtarchycardia,flutterorfibrillation

ECG超声心动图特异性诊断价值心脏外周均匀存在液性暗区心脏压塞的超声表现舒张期右房和右室游离壁塌陷吸气时右室内径增大左心室内径缩小和室间隔左移定量，心包厚度EchocardiogramSpecificdiagnosisFluidityareasopacainheartperipheryCardiactamponadeRightatrialandventricularfreewallcollapseRightventricleinnerdiameterincreaseininhaleQuantization:thicknessofpericardiumEchocardiogramFibiousEffusion实验室检查CT或磁共振显像

心包厚度和心包积液量及分布情况帮助分辨积液性质心包活检用于病因诊断

心包穿刺

心包液体的性质生化检查生物学检查病理学检查心脏压塞或治疗需要在超声定位指导下进行

LaboratoryexaminationCT,MRI

Thicknessofpericardium,quantityanddistributionofhydropericardiumQualityofhydroperi-cardiumPericardialbiopsyForetiologicaldiagnosisParacentesispericardiiQualityofhydropericardium

biochemistry

biologytest

pathologytestTreatmentofcardiactamponade诊断

病因学诊断心包炎诊断心包炎伴渗液心包炎可能病史、心包穿刺、影像学和活检X线检查、心电图、超声心动图同时伴有呼吸困难、心动过速体循环淤血和心脏增大的体征胸痛心包摩擦音Diagnosis

EtiologicaldiagnosisDiagnosisEffusionPericarditisHistory、paracentesispericardii、ImageologyandbiopsyX-ray、ECG、ECHOAccompaniedwith

dyspnea,tachycardia,congestionofsystemiccirculationandcardiacenlargementThoracalgia,pericardialrub非特异性心包炎：主要特点

上呼吸道感染前驱症状持续发热胸痛剧烈心包摩擦音明显血培养阴性心包积液量较少NonspecificpericarditisUpperrespiratoryinfectionPersistentfeverSeverechestpain

PericardialrubNegativehemocultureLittlehydropericardium结核性心包炎：主要特点常伴原发性结核病灶

低热

心包摩擦音少有心包积液常大量，多为血性，淋巴细胞比例高，可找到结核杆菌TuberculouspericarditisAccompaniedwith

primarytuberculosisLow-gradefeverRarepericardialrubHydropericardiummultiplicity，upright，largeproportionlymphocyte,bacillustuberculosiscanbefound肿瘤性心包炎：主要特点转移性肿瘤多见胸痛不明显心包摩擦音少见心包积液常大量，多为血性，淋巴细胞比例高，可见异型细胞NeoplastiepericarditisMetastatictumorSlightthoracalgiaRarepericardialrubHydropericardiummultiplicity,upright,largeproportionlymphocyte,allotypecellscanbefound化脓性心包炎：主要特点原发感染病灶和败血症高热胸痛不明显心包摩擦音少白细胞计数明显增高心包积液较多，脓性，主要为中性粒细胞，可找到化脓性细菌

PurulentpericarditisPrimaryinfectionHyperpyrexia

Slight

thoracalgiaRarepericardialrubIncreasedleucocytescount

Hydropericardiummultiplicity,

purulence,largeproportionneutrophil,bacteriumcanbefound风湿性心包炎：主要特点全心炎的一部分，伴风湿热其他表现

不规则轻中度发热

常有胸痛心包摩擦音常有心包积液量少，多呈草绿色，主要为中性粒细胞RheumaticpericarditisPartofpancarditis,accompaniedwiththeothermanifestationofrheumaticfeverIrregularmoderatefeverThoracalgia

PericardialrubFew,prasinoushydropericardium,largeproportionneutrophil.

心脏损伤后综合征：主要特点手术或心肌梗死等心脏损伤病史

常有发热常有胸痛心包积液较少，草黄色或血性，淋巴细胞较多可复发

HeartinjurysyndromeHistoryofoperation,myocardialinfarctionor

heartinjury

FeverThoracalgiaFewprasinousoruprighthydropericardiumRelapse

鉴别诊断胸痛为主要症状

急性心肌梗死患者年龄较大无上呼吸道感染史心电图有异常Q波、ST段呈弓背向上抬高和T波倒置并呈动态演变血清心肌标志物或心肌酶学指标升高疼痛主要在上腹部急腹症病史、体格检查以呼吸困难、心界扩大为主要表现

心肌病、先心病等体征、X线检查、心电图和超声心动图DifferentialdiagnosisThoracalgiaAMIOldpatientsNohistoryofupperrespiratoryinfectionECG:Qwave,STelevation,Twavedepressionanddynamicalteration

MyocardiummarkerandcardiaccreatasePain

inepigastAcuteabdomenHistory,medicalexaminationDyspneaCardiomyopathy,congenitalheartdiseaseSign,X-ray,ECG,ECHO结核性心包炎早期、足量、联合抗结核药物治疗化脓性心包炎

足量有效的抗生素心包穿刺排脓心包腔内注入抗生素非特异性心包炎和心脏损伤综合征无特异性治疗应用肾上腺皮质类固醇考虑秋水仙碱1~2mg/天风湿性心包炎加强抗风湿治疗肾上腺皮质类固醇反应较好治疗病因治疗缓解心脏压塞对症治疗结核性心包炎早期、足量、联合抗结核药物治疗化脓性心包炎

足量有效的抗生素心包穿刺排脓心包腔内注入抗生素Nonspecificpericarditisandheartinjurysyndrome

Nospecifictreatment

AdrenalcorticalsteroidRheumaticpericarditisAnti-rheumatismtreatmentadrenalcorticalsteroidTreatmentEtilogicaltreatmentCardiactamponadereliefSymptomatictreatment治疗心包穿刺超声定位指导X线透视下进行心包切开引流术化脓性心包炎心包切除术非特异性心包炎有反复发作者穿刺点左侧第五肋间心浊音界内侧约1~2厘米处病人取坐位胸骨剑突与左肋缘相交处病人取半坐位迷走性低血压反应阿托品病因治疗缓解心脏压塞对症治疗TreatmentParacentesis

Ultrasoundlocatization

X-rayPericardiumincisionanddrainage

purulentpericarditisPericardectomyNonspecificpericarditisrecurrentattacks

ParacentesisFifthribEnsiformprocessofsternumintersectwithleftcostalborder

Seatedleaning-forwardpositionHypotensionresponse--atropineEtilogicaltreatmentCardiactamponadereliefSymptomatictreatment治疗住院观察卧床休息至发热及胸痛症状消失水肿者给予利尿剂加强支持治疗胸痛剧烈者非甾体类抗炎药物阿斯匹林600mg，每3~4小时1次消炎痛25mg~50mg，每6小时一次吗啡或左侧星状神经节封闭病因治疗缓解心脏压塞对症治疗治疗HospitalizationCompletebedrestuntilthedisappearanceoffeverandthoracalgiaEdemapatientsDiuretic

SupportivetreatmentSeverethoracalgia

non-steroidanti-inflammatorydrug(NSAID):

Aspirin

IndomethacinMorphineLeftganglionstellareblockageEtilogicaltreatmentCardiactamponadereliefSymptomatictreatment预后取决于病因结核性或化脓性心包炎经过及时有效的治疗痊愈缩窄性心包炎非特异性心包炎患者易复发并发于急性心肌梗死、恶性肿瘤或结缔组织病者预后较差PrognosisDependsonetiologicalfactorTuberculousandpurulentpericarditis:healingafterpromptlytreatmentConstrictivepericarditisNonspecificpericarditisusuallyrelapsePatientsaccompaniedwithAMI,malignanttumororconnectivetissuediseasemayhavebadprognosis缩窄性心包炎病因:结核最常见临床表现：症状心包积液压迫症状呼吸困难咳嗽声音嘶哑