体外循环心内直视手术后并发心脏压塞13例报告

CARDIAC TAMPONADE AFTER OPEN HEART SURGERY: A REPORT OF 13 CASES

本文报道手术后并发心脏压塞13例,其中急性心脏压塞10例,延期心脏压塞3例,发生率为1.3%。主要原因为手术后出血或渗血量多而引流不畅或阻塞,其次为增大的心脏心包缝合过紧,胸骨压迫等。作者认为:对重症患者术后常规留置左房测压管进行左房压监测或以Swan-Ganz导管进行监测,有助于早期鉴别诊断。防止术后出血渗血过多和改进引流方法可降低心脏压塞的发生率。及早处理,缩短低血压时间,避免心搏停止和继发多脏器功能衰竭是降低死亡率的关键。瓣膜替换术后应用抗凝治疗可能会发生延期心脏压塞并发症,应引起足够的重视。

From Jan 1981 to June 1987,cardiac tamponade occurred in 13 cases(1.3%)out of 992 open heart operations.Ten cases were of acute type and the other 3 delayed type.Postoperative profuse bleeding or massive oozing associated with obstruction of the drainage tube was the primary cause.Other etiological factors were too tight closure of the pericardium and compression of the sternum upon the much enlarged heart.The authors point out that retention of a left atrial catheter or Swan-Ganz catheter is helpful in differential diagnosis of ambiguous cases.A modified method of pericardial drainage is described.Early management before appearance of profound hypotension,cardiac arrest or multiple organ failure is the key to decrease mortality.In valvular replacement using anticoagulant,attention should be paid to the possibility of delayed cardiac tamponade.