6 курс / Кардиология / Джон_Кэмм_Болезни_сердца_и_сосудов_2011
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ГЛАВА 19. ЗАБОЛЕВАНИЯ ПЕРИКАРДА
Jordi Soler-Soler и Jaume Sagristа-Sauleda
РЕЗЮМЕ
Заболевания перикарда не относятся к категории редких нозологических форм. Их диагностика, как правило, не вызывает проблем, и прогноз заболевания в большинстве случаев благоприятный. Однако выбор метода лечения в этой группе заболеваний нередко представляет определенные трудности. Клинические варианты заболеваний перикарда включают в себя острый воспалительный перикардит, перикардиальный выпот, тампонаду сердца и констриктивный перикардит. Эти патологические состояния иногда сочетаются. Острый перикардит - наиболее частое заболевание перикарда. В связи с этим большое внимание в данной главе уделено его клиническим проявлениям. Обсуждены преимущества и ограничения инвазивных перикардиальных вмешательств, сложных лабораторных тестов выпотной жидкости и ткани перикарда, а также приведены рекомендации по выполнению перикардиоцентеза и биопсии перикарда. Выпот в полость перикарда встречается довольно-таки часто, как изолированный клинический синдром, так и сочетающийся с другими перикардиальными или экстракардиальными заболеваниями, которые описаны отдельно. Правильная диагностика и ведение констриктивного перикардита - важная проблема, подходы к решению которой в последние годы существенно расширились. Более того, при наличии соответствующих показаний к перикардиотомии данное заболевание успешно лечится. Описаны основные клинические проявления и принципы ведения пациентов с наиболее важными специфическими формами перикардита. Кроме того, в данной главе уделено внимание некоторым редким заболеваниям перикарда.
ВВЕДЕНИЕ
Перикард представляет собой мешок с двумя фиброзно-серозными слоями, которые окружают сердце. Перикард может поражаться большим количеством разнообразных агентов и процессов [1-3]. Однако ответ на патологический процесс практически всегда одинаков и представлен воспалительным симптомокомплексом, включающим болевой синдром в грудной клетке и лихорадку, гиперпродукцию перикардиальной жидкости с возможными осложнениями в виде тампонады сердца, а также утолщением и кальцификацией перикарда, сужением его полости, что приводит к развитию констриктивного перикардита. С клинической точки зрения, самое частое проявление - острый перикардиальный синдром (острый перикардит и тампонада). Перикардиальный выпот может быть одним из симптомов заболеваний перикарда различной этиологии, но иногда является изолированной находкой.