* * ( r e n a l replacement therapy) [1] ( ) (uremic pericarditis) (dialysis-associated pericarditis) (cardiac tamponade) (morbidity) ( ) (anasarca) 194/130 118 X 143 mg/dl 6.4 mg/dl 118 meq/l 84 95 18 2 084-92/360- 徐 永 勳.indd 84 2006/9/20 2:53:28 PM
4.8 meq/l 5.1 g/dl (Furosemide 50 mg ) (nitroglycerin thiazide doxazosin amlodipine dilatrend) (5 10 147 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) 160 4.7 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) 20 4.5 mg/dl 圖 1. 胸 部 X 光 心 臟 嚴 重 擴 大 且 呈 水 瓶 狀 2. 95 18 2 85 084-92/360- 徐 永 勳.indd 85 2006/9/20 2:53:29 PM
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) 0.0 0.24 (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) 86 95 18 2 084-92/360- 徐 永 勳.indd 86 2006/9/20 2:53:30 PM
1. ( ) (fibrinous) (effusive) ( [serous] [sanguinous]) ( ) (effusive-constrictive) (constrictive) ( ) (constrictive) (effusive) (adhesive) * Harrison s Principle of Internal Medicine 15th Edition Table 239-1 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) 10 5. (Laboratory manifestation) (leukocytosis) (erythrocyte sedimentation rate) X 97~100% (cardiomegaly) ( 2 4) avr Lead I ST PR T (inversion) (sinus tachycardia) (low voltage) 95 18 2 87 084-92/360- 徐 永 勳.indd 87 2006/9/20 2:53:31 PM
(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) 10 14 (central venous pressure) Swan-Ganz (PCWP) (heparin) 2. J-ST (segment) T PR (upright) (depressed) (upright) (depressed) (flat) (depressed) (isoelectric) (inverted) (inverted) (upright) * 188~191 88 95 18 2 084-92/360- 徐 永 勳.indd 88 2006/9/20 2:53:31 PM
* 188~189 15-1 15-2 4. (4a) (4b) [8] 95 18 2 89 084-92/360- 徐 永 勳.indd 89 2006/9/20 2:53:32 PM
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 239-1 Classification of Pericarditis (Page 1366) ( 76% ) 15% 66% [7] (wound dehiscence) ( [subxiphoid] ) 36~ 80% [3,7] (pericardiectomy) (pericardiostomy) (limited) (constriction) 90 95 18 2 084-92/360- 徐 永 勳.indd 90 2006/9/20 2:53:32 PM
(loculated) 5 [9] ( 5) 8. (Prognosis) 76 15% ( 66%) [7] (1) 39.0 (2) 100 (3) 15000 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: 35-40. 2. Compty CM, Cohen SL, Shapiro FL: Pericarditis in chronic uremia and its sequels. Ann Intern Med 1971; 75: 173-83. 3. Renfrew R, Buselmeier TJ, Kjellstrand CM: Pericarditis and renal failure. 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. Gunukula SR, Spodick DH: Pericardial disease in renal patients. Semin Nephrol 2001; 21(1): 52-6. 6. Spodick DH. Acute cardiac tamponade. N Engl J Med 2003 Aug 14; 349(7): 684-90. 7. Rostand SG, Rutsky EA: Pericarditis in end-stage renal disease. Cardiol Clin 1990; 8(4): 701-7. 8. 188-9. 9. Wood JE, Mahnensmith RL: Pericarditis associated with renal failure: evolution and management. Semin Dial 2001; 14(1): 61-6. 10. 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): 588-92. 95 18 2 91 084-92/360- 徐 永 勳.indd 91 2006/9/21 3:16:39 PM
5. 92 95 18 2 084-92/360- 徐 永 勳.indd 92 2006/9/20 2:53:35 PM