探讨不同治疗方案对于快速进展为缩窄性心包炎的结核性心包炎（快速进展型结核性心包炎）治疗效果、并发症、死亡率、患者预后的影响，以期对结核性心包炎的治疗获得更好的效果。

回顾性分析2014年6月至2019年5月成都市第三人民医院心脏大血管外科对38例快速进展型结核性心包炎的治疗方式、外科手术干预时机、手术方式及疗效、并发症、死亡率和随访情况等，治疗方式包括药物治疗、心包穿刺引流术、心包开窗术、心包剥脱术等。同期观察对慢性缩窄性心包炎行外科手术治疗患者115例。

对于快速进展型结核性心包炎采用不同的治疗方案，随访1~5年。所有患者均采用抗结核药物治疗，其中单纯药物治疗5例，全部进展为缩窄性心包炎；早期行心包穿刺引流术12例，治愈1例，其余11例进展为慢性缩窄性心包炎；早期行心包开窗术10例，进展为慢性缩窄性心包炎1例，治愈9例；早期行心包剥脱术11例，无进展为慢性缩窄性心包炎病例。全组无围术期死亡病例。与同期行慢性缩窄性心包炎外科手术治疗患者相比，快速进展型结核性心包炎外科手术治疗患者低心排综合征发生率较低（4.8% vs 24.3%，P＜0.05），患者心功能改善情况较好（100.0% vs 80.7%，P＜0.05），术后5年随访生存率较高（100% vs 78%，P＜0.05）。

快速进展型结核性心包炎单纯采用药物治疗和心包穿刺术治疗，有很高比例的患者会进展为缩窄性心包炎，从而严重影响患者的预后。早期外科干预能显著降低快速进展型结核性心包炎进展为缩窄性心包炎的概率，从而改善患者总体预后，改善患者生存质量，减轻社会负担。

To explore the clinical effects, complications, mortality, and prognosis associated with different treatment schemes for tuberculous pericarditis with rapid progression to constrictive pericarditis (rapidly progressive tuberculous pericarditis), in order to obtain better therapeutic effects for the treatment of tuberculous pericarditis.

From June 2014 to May 2019, 38 cases of rapidly progressive tuberculous pericarditis were treated by different treatments. The timing, method and effect of surgical intervention, complications, mortality, and follow-up data were analyzed retrospectively. Treatment methods included drug therapy, pericardiocentesis and drainage, pericardiotomy, and pericardiectomy. Meanwhile, 115 cases of chronic constrictive pericarditis treated surgically were also observed.

Different treatment schemes were used for the treatment of rapidly progressive tuberculous pericarditis, with a follow-up of 1-5 years. All patients were treated with antituberculosis drugs. Among all cases involved, 5 were treated with drugs alone and all of them developed into constrictive pericarditis; 12 were treated by pericardiocentesis and drainage in early stage, of which 1 was cured, and the other 11 developed into chronic constrictive pericarditis; 10 were treated by pericardiotomy in early stage, of which 1 developed into chronic constrictive pericarditis and 9 were cured; 11 underwent early pericardiectomy and there was no progression to chronic constrictive pericarditis. No perioperative deaths occurred. Compared with the patients with chronic constrictive pericarditis who underwent surgical treatment in the same period, the incidence of low cardiac output syndrome was lower in patients with rapidly progressive tuberculous pericarditis who underwent surgical treatment (4.8% vs 24.3%, P＜0.05), the improvement of cardiac function was better (100.0% vs 80.7%, P＜0.05), and the 5-year follow-up survival rate was higher (100% vs 78%, P＜0.05).

A high proportion of cases of rapidly progressive tuberculous pericarditis treated only with drugs or by pericardiocentesis will progress to constrictive pericarditis, which will seriously affect the prognosis of patients. Early surgical intervention can significantly reduce the rate of rapidly progression of tuberculous pericarditis to constrictive pericarditis, thus improving the overall prognosis of patients and their quality of life and reducing the social burden.