4.8 meq/l 5.1 g/dl (Furosemide 50 mg ) (nitroglycerin thiazide doxazosin amlodipine dilatrend) ( mg/dl 9.4 mg/dl) 5 11 (orthopnea) 96/69 mmhg

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7 years ago
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1 * * ( r e n a l replacement therapy) [1] ( ) (uremic pericarditis) (dialysis-associated pericarditis) (cardiac tamponade) (morbidity) ( ) (anasarca) 194/ X 143 mg/dl 6.4 mg/dl 118 meq/l /360- 徐永勳.indd /9/20 2:53:28 PM

tamponade) (morbidity) ( ) (anasarca) 194/130 118 X 143 mg/dl

2 4.8 meq/l 5.1 g/dl (Furosemide 50 mg ) (nitroglycerin thiazide doxazosin amlodipine dilatrend) ( mg/dl 9.4 mg/dl) 5 11 (orthopnea) 96/69 mmhg 5 12 X (water bottle cardiac silhouette) ( 1) (electrical alternans) (cardiac tamponade) (pericardial effusion) 3.25 (fibrin-like) ( 2) pig-tail 1850 ( 3) g/dl 126 mg/dl (LDH) 2423 IU/L ( 5.6 g/dl 766 IU/L 9080/ul 80.6% exudative) 17.5% ( 42.3%)! (intensive hemodialysis) mg/dl 圖 1. 胸部 X 光心臟嚴重擴大且呈水瓶狀 /360- 徐永勳.indd /9/20 2:53:29 PM

(pericardial effusion) 3.25 (fibrin-like) ( 2) pig-tail 1850 ( 3) 160 4.7 g/dl 126 mg/dl (LDH) 2423 IU/L ( 5.

3 12% [3] [4] 圖 3. 引流出之心包膜積液心包穿刺術引流出暗紅色積液, 放置後不凝固 (classification) ( 1) (fibrinous) (effusive) (constrictive) ( 1) ( ) (fibrinous) (serofibrinous) [1] 1. (Epidemiology) 3~41% 2~21% [2] 2. (Pathology) (fibrinous fibrofibrinous pericarditis) (hemorrhagic) (serofibrinous) (Hematocrit) (exudative) (adhesive pericarditis) (serosanguineous) [4] 3. (Pathogenesis) ( 76%) [4] (inadequate dialysis) (volume overload) (immune complex) (middle molecules) (heparin) ( cytomegaloviruses) (hyperparathyroidism) (hypercalcemia) [5] ( hydralazine α-methyldopa procainamide minoxidil) /360- 徐永勳.indd /9/20 2:53:30 PM

(Epidemiology) 3~41% 2~21% [2] 2. (Pathology) (fibrinous fibrofibrinous pericarditis) (hemorrhagic) (serofibrinous) (Hematocrit) 0.0 0.

4 1. ( ) (fibrinous) (effusive) ( [serous] [sanguinous]) ( ) (effusive-constrictive) (constrictive) ( ) (constrictive) (effusive) (adhesive) * Harrison s Principle of Internal Medicine 15th Edition Table Classification of Pericarditis (Page 1366) 4. (Clinical features) (pericardial friction rub) (high-pitched) (malaise) X Ewart s sign ( [dullness]) (distant heart sound) 3% 20% ( ) [6] (pulsus paradoxus) (Laboratory manifestation) (leukocytosis) (erythrocyte sedimentation rate) X 97~100% (cardiomegaly) ( 2 4) avr Lead I ST PR T (inversion) (sinus tachycardia) (low voltage) /360- 徐永勳.indd /9/20 2:53:31 PM

(Clinical features) (pericardial friction rub) (high-pitched) (malaise) X Ewart s sign ( [dullness]) (distant heart sound) 3% 20% ( ) [6] (pulsus paradoxus) 10 5.

5 (electrical alternans) (0~41%) [7] 19~30% (supraventricular) (small amount) ( ) (moderate amount) (large amount) 6. (Differential diagnosis) X / ( 3) (bloody) (rheumatic fever) (post-cardiac injury) (idiopathic) 7. (Treatment) (intensive hemodialysis) (NSAID) (pericardiocentesis) (pericardiectomy) (pericardiostomy/ pericardial window) (intra-pericardial long-acting nonabsorbable glucocorticoid installation) (central venous pressure) Swan-Ganz (PCWP) (heparin) 2. J-ST (segment) T PR (upright) (depressed) (upright) (depressed) (flat) (depressed) (isoelectric) (inverted) (inverted) (upright) * 188~ /360- 徐永勳.indd /9/20 2:53:31 PM

(Treatment) (intensive hemodialysis) (NSAID) (pericardiocentesis) (pericardiectomy) (pericardiostomy/ pericardial window) (intra-pericardial long-acting nonabsorbable

6 * 188~ (4a) (4b) [8] /360- 徐永勳.indd /9/20 2:53:32 PM

7 3. (autoimmunity) (hypersensitivity) (collagen vascular disease) (SLE) (RA) (AS) (scleroderma) Wegener granulomatosis Procainamide hydralazine phenytoin isoniazide minoxidil anticoagulants (myocardial infarction) (cardiotomy) (uremia) (neoplasia) (myxedema) (aortic dissection) (post-irradiation) (sarcoidosis) (chylopericardium) (trauma) (familial) (idiopathic) * Harrison s Principle of Internal Medicine 15th Edition Table Classification of Pericarditis (Page 1366) ( 76% ) 15% 66% [7] (wound dehiscence) ( [subxiphoid] ) 36~ 80% [3,7] (pericardiectomy) (pericardiostomy) (limited) (constriction) /360- 徐永勳.indd /9/20 2:53:32 PM

(trauma) (familial) (idiopathic) * Harrison s Principle of Internal Medicine 15th Edition Table 239-1 Classification of Pericarditis (Page 1366) ( 76% ) 15% 66% [7]

8 (loculated) 5 [9] ( 5) 8. (Prognosis) 76 15% ( 66%) [7] (1) 39.0 (2) 100 (3) cell/hpf (4) (left shift) (5) (6) (7) [10] (Discussion) ( procainamide hydralazine isoniazide anticoagulants ) 1. Falk RJ: Pericarditis in renal failure: Kidney Int 1981; 14: Compty CM, Cohen SL, Shapiro FL: Pericarditis in chronic uremia and its sequels. Ann Intern Med 1971; 75: Renfrew R, Buselmeier TJ, Kjellstrand CM: Pericarditis and renal failure. Annu Rev Med 1980; 31: Alpert MA, Ravenscraft MD: Pericardial involvement in endstage renal disease. Am J Med Sci 2003; 325(4): Gunukula SR, Spodick DH: Pericardial disease in renal patients. Semin Nephrol 2001; 21(1): Spodick DH. Acute cardiac tamponade. N Engl J Med 2003 Aug 14; 349(7): Rostand SG, Rutsky EA: Pericarditis in end-stage renal disease. Cardiol Clin 1990; 8(4): Wood JE, Mahnensmith RL: Pericarditis associated with renal failure: evolution and management. Semin Dial 2001; 14(1): Morin JE, Hollomby D, Gonda A, Long R, Dobell AR: Management of uremic pericarditis: a report of 11 patients with cardiac tamponade and a review of the literature. Ann Thorac Surg 1976; 22(6): /360- 徐永勳.indd /9/21 3:16:39 PM

Annu Rev Med 1980; 31: 345-60. 4. Alpert MA, Ravenscraft MD: Pericardial involvement in endstage renal disease. Am J Med Sci 2003; 325(4): 228-36 5.

9 /360- 徐永勳.indd /9/20 2:53:35 PM

導程心電圖 ( 圖一上 ) 在導程 I,aVL 呈現 ST 節段上昇超過 1.5mm; 導程 III, avf 呈現 ST 節段下降超過 1.5mm 之反相對等變化 (reciprocal change) 經確診為 killip I 高位

導程心電圖 ( 圖一上 ) 在導程 I,aVL 呈現 ST 節段上昇超過 1.5mm; 導程 III, avf 呈現 ST 節段下降超過 1.5mm 之反相對等變化 (reciprocal change) 經確診為 killip I 高位血栓溶解劑導致出血性心包膜填塞 - 急性心肌梗塞之罕見合併症一病例報告及文獻回顧蔡政廷侯嘉殷周友三蔡正河馬偕紀念醫院心臟內科摘要急性心肌梗塞投予血栓溶解劑後可能產生出血性心包膜填塞, 造成心因性休克, 特別好發於