心包穿刺置管引流术治疗大量心包积液57例

PERICARDIOCENTESIS AND DRAINAGE BY CATHETER IN 37 LARGE PERICARDIAL EFFUSION PATIENTS

目的：探讨心包穿刺引流术的方法、引流时间、引流体位、引流量的控制。方法：患者取半卧位,超声心动图定位穿刺点、穿刺深度及方向。根据探及情况选用心尖部或剑突下进针。采用Seldinger's法将中心静脉导管送人心包腔内,连接无菌引流袋引流积液。结果：57例患者心包穿刺均获成功,未出现并发症。引流导管留置时间1～25d,平均4.5±2d。引流积液量380～3500mL,平均1150±650mL。穿刺引流后患者胸闷、气促明显改善,颈静脉怒张消失。术后患者心率减慢(由106±28次／分钟降至92±30次／分钟,P＜0.05)。心功能亦获明显改善。结论：seldinger导管法用于心包穿刺安全,可避免损伤心肌,引流彻底,疗效可靠。

Objective： To explore the method for pericardiocentesis and drainage, the duration, posture of drainage and the fluid volume in pericardial effusion patients. Method ： 57 patients, male 35, fereal 22, age 16 -73 years old （main 49 ± 13） half lying on the bed, the puncture was performed via the sub xiphoid route or the apex of heart route after the site, depth and direction of needle entry were confirmed by echocardiograp. Using seldinger method, we put the central venous indwelling catheter into pericardial sac and connect it with an aseptic bag for drainage. Results： Catheter pericardiocentesis in 57 patients was successful without complications. Duration of use of the indwelling pericardial catheter ranged from 1 day to 25 days, the average is 4. 5 ± 2 days. The fluid volume removed was 380 to 3500 milliliters, mean volume is 1150 ± 650ml. After drainage, chest discomfort and short breath were alleviated obviously. Prominent jugular veins disappeared. Reductions of heart rate were significant. Cardiac function improved. Conclusion ： Seldinger technique is a safe method for pericardiocentesis and drainage with the assistance of echocardiographic diagnosis and guidance. It can avoid myocardial trauma and drain the pericardial effusions effectively.