心脏外科手术后迟发性心包填塞的临床研究

Clincal study of delayed pericardial tamponade after cardiac surgical procedure

目的探讨心脏外科手术后迟发性心包填塞的诊断和治疗方法。方法选择我院15例心脏手术后发生迟发性心包填塞的病人进行研究分析。结果2例死亡,13例治愈。死亡率和发病率分别为13.3%(2/15)和0.95%(15/1579)。结论心脏手术1周以后病人出现低心排和充血性心衰表现时,应当高度怀疑迟发性心包填塞的存在,尤其是正在接受抗凝治疗和内科治疗低心排和心衰不见改善时,应立即进行心脏超声检查。心脏超声检查对迟发性心包填塞的诊断具有重要价值。如果迟发性心包填塞诊断成立,则应及时手术治疗。

Objective To investigate the diagnosis and treatment of delayed pericardial tamponade after cardiac surgical procedure. Methods We retrospectively studied a cohort of 15 patients who were with delayed peficardial tamponade after undergoing cardiac surgical procedure between June 1995 and June 2007 in our department. Results The mortality and morbidity were 13.3 percent（2/15 ） and 0.95 percent（15/1579）. Conclusions This severe com- plication is often ignored because of its features of delitescence. The diagnosis of delayed pericardial tamponade is ambiguous in any patient with a low cardiac output state or congestive heart failure after a week postoperatively. This is particularly suspectable if the patient did not get better after medical therapy for low cardiac output and heart failure. Echocardiography is most valuable for the diagnosis of delayed peficardial tamponade. Promptly reexploration to decompress is the most effective method of treating delayed pericardial tamponade.