There are four methods for the treatment of tuberculous pericarditis

What is the treatment for tuberculous pericarditis has always been the most concerned issue for patients with tuberculous pericarditis. In fact, there are four treatments for tuberculous pericarditis. The first is systemic anti-tuberculosis treatment, but it lasts for a very long time, with a total course of 1.5 to 2 years.

1. Systemic anti-tuberculosis treatment:

If the tuberculin skin test is positive and the clinical signs are consistent with tuberculous pericarditis, antituberculosis treatment should be initiated.

A combination of 4 to 6 first-line anti-tuberculosis drugs is used, with a total treatment course of 1.5 to 2 years.

Symptomatic treatment (if necessary, if the patient has chest tightness and dyspnea, appropriate amount of fluid can be drawn, if there is edema in both lower limbs, diuretics can be given, and the 24-hour intake and output should be recorded, etc.).

2. Corticosteroid treatment

The use of corticosteroids during anti-tuberculosis treatment can significantly improve clinical symptoms, reduce pericardial puncture, significantly reduce the incidence of constrictive pericarditis, reduce pericardiectomy and reduce mortality. Early and high-dose prednisone treatment of TBP can quickly improve the patient's symptoms and has a significant therapeutic effect.

Usage: Prednisone 60-120 mg/d, reduce the dosage after 1 month, for a total of 11 weeks.

3. Pericardiocentesis and local drug treatment

When effusion occurs quickly or in large amounts and cardiac tamponade occurs, drainage treatment is necessary. Currently, it is advocated to place a catheter for drainage. At the same time, local injection of anti-tuberculosis drugs, hormones, urokinase or streptokinase, heparin, hyaluronic acid, etc. into the pericardial cavity can effectively reduce the chances of exudation, pericardial thickening and fibrin deposition, and greatly reduce the occurrence of constrictive pericarditis.

4. Surgical treatment

Recurrent pericardial effusion or the occurrence of cardiac tamponade and pericardial thickening, and persistent increase in systemic venous pressure after 4 to 6 weeks of anti-tuberculosis treatment are indications for surgical pericardectomy.

Elective surgical treatment should be emphasized. Subacute constrictive pericarditis that does not improve after 4 to 6 weeks of treatment; chronic constrictive pericarditis that worsens or has calcified should be treated surgically.

In recent years, the Department of Tuberculosis I has carried out thoracic cavity (pericardial cavity) injection of urokinase to treat loculated thoracic (pericardial) effusion and achieved good results.