体外循环术后急性心包填塞的预防和治疗

Prevention and treatment of postoperative acute cardiac tamponade after CPB surgery

目的：总结我科１０８０例体外循环（ＣＰＢ）术后急性心包填塞（ＡＣＴ）的防治经验。临床资料：全组病例１０８０例，先心病８７６例，瓣膜置换２０４例，全部手术均在全麻低温ＣＰＢ下完成心内操作，升主动脉阻断时间：先心病１０～８９ｍｉｎ（２８６±１４９ｍｉｎ），瓣膜置换３４～６８ｍｉｎ（４３２±７２ｍｉｎ）。结果：全组发生ＡＣＴ１６例（１４８％），１４例为全心性心包填塞，２例为局限性心包填塞。１６例ＡＣＴ主要原因包括活动性出血（６／１６），试用凝血酶冲洗纵隔创面（６／１６），心包、纵隔引流管管理不善（４／１６）。１６例中无１例死亡。结论：ＡＣＴ的预防在于手术中彻底止血，术后定期挤压引流管。纵隔创面忌用凝血制剂冲洗。ＡＣＴ一经诊断，应及时开胸探查止血，清除血块，解除心脏压塞。

Objective:To summarize the experience of prevention and treatment of the early postoperative acute cardiac tamponade(ACT)in 1 080 patients with cardiopulmonary bypass(CPB)surgery,including 876 with congenital heart disease(CHD)and 204 with rheumatic heart disease(RHD),Materials:All patients were operated on under general anesthesia and hypothermic CPB.The aorta clamp time:CHD 10～89 min(28 6±14 9 min)and RHD 34～68 min(43.2±7.2 min).Results:Of the 1 080 patients 16 complicated with ACT in early postoperative stage,14 presented as compression of the whole heart,2 as localized compression of the right atrium and the junction of the superior vena cava with the right atrium respectively by clots.The main causes of the 16 cases of ACT included active bleeding(6/16),unwisely flushing the media stinal wound and the pericardial sac with coagulant(thrombin,6/16),and improper management of the cardiac and mediastinal drainage catheters(4/16).Conclussion:The prophilactic measures of preventing the complication of ACT include comeplete and thorough hemostasis during opereation,not trying to stop the oozing by using coagulants to flush the mediastinal wound or pericardial sac before closing the chest,and proper management of the drainage catheters postoperatively.The ACT has been diagnosed and reoperation should be done urgently.