PDF(Pubmed)
Abstract：
Pericardial effusions, especially large ones, have traditionally been regarded with concern by clinicians due to the sometimes unpredictable development of life-threatening cardiac tamponade. In the European Society of Cardiology Guidelines on pericardial diseases, the simplified algorithm for pericardial effusion triage and management recommends pericardial drainage in cases of cardiac tamponade and/or suspicion of bacterial or neoplastic etiology. In the presence of acute pericarditis, empiric anti-inflammatory treatment should be given, while when a specific indication known to be associated with pericardial effusion is found, then treatment of the underlying cause is indicated. Notably, the most challenging subgroup of patients includes those with large, asymptomatic, C-reactive-protein-negative, idiopathic effusions. In the latter subjects, pericardial drainage is proposed in cases of chronic effusions (lasting more than three months). However, this recommendation is based on scant data stemming from small-sized non-randomized studies. Nevertheless, recent evidence in a larger cohort of patients pointed out that a watchful waiting strategy is a safe option in terms of complication-free survival. This review summarizes the contemporary evidence on this challenging topic and provides recommendations for tailoring individual patient treatments.
摘要：
心包积液,尤其是大的，传统上，由于有时危及生命的心脏压塞的发展不可预测，临床医生一直对此表示关注。在欧洲心脏病学会心包疾病指南中，心包积液分流和处理的简化算法建议在心包填塞和/或怀疑细菌或肿瘤病因的情况下进行心包引流.在急性心包炎的情况下，应给予经验性抗炎治疗，而当发现已知与心包积液相关的特定适应症时，然后指出根本原因的治疗。值得注意的是,最具挑战性的患者亚组包括那些大，无症状，C反应蛋白阴性,特发性积液.在后面的科目中，在慢性积液（持续三个月以上）的情况下，建议进行心包引流。然而,这项建议是基于来自小型非随机研究的少量数据.然而，在更大的患者队列中最近的证据指出,就无并发症生存而言,观察等待策略是一种安全的选择.这篇综述总结了关于这一具有挑战性的主题的当代证据，并为定制个体患者治疗提供了建议。
