Seldinger技术指导心包穿刺置管引流治疗急性心肌梗死溶栓并发心包积液

Application of Seldinger technique to facilitate percutaneous pericardial drainage with indwelling catheter in the management of pericardial effusion in acute myocardial infarction cases

目的评价Seldinger技术指导心包穿刺置管引流治疗急性心肌梗死溶栓并发心包积液的疗效及安全性方法急性心肌梗死溶栓并发心包积液18例,在床边超声心动图定位指导,采用Seldinger技术,经皮穿刺并内置深静脉留置导管进行心包腔内持续或间断引流心包积液。结果 18例患者均1次穿刺并留置导管引流成功,未出现因继发感染、出血、血气胸、严重心律失常、心脏穿破及与心包穿刺置管导致的死亡。留置时间7～21 d,平均(9.4±3.7)d;引流量为180～450ml,平均(190±50)ml。结论采用Seldinger技术心包穿刺置管引流治疗急性心肌梗死溶栓并发心包积液,方法简单,安全有效,成功率高,可替代传统穿刺方法 。

Objective To evaluate the effectiveness and safety of using Seldinger technique to facilitate percutaneous pericardial drainage with indwelling catheter in the management of pericardial effusion in the cases of acute myocardial infarction. Methods Eighteen patients with acute myocardial infarction complicated by pericardial effusion resulted from thrombus dissolving were treated with percutaneous indwelling deep vein catheter for continuous or interval pericardial drainage by using Seldinger technique under the guidance of echocardiography. Results Eighteen patients were all treated successfully with percutaneous indwelling catheter drainage for pericardial effusion. No death occurred resulting from secondary infection ,haemorrhage,pneumothorax, severe arrhythmia or perforation. Using pericardial indwelling catheter,the drainage time was 7-21 d（9.4±3.7 d） and the drainage volume was 180-450 m1（190±50 ml）. Conclusion The use of Seldinger technique to facilitate percutaneous pericardial drainage with indwelling catheter is a simple,safe and effective method. It reaches high successful rate in the management of pericardial effusion after thrombus dissolving in acute myocardial infarction. It may take place the traditional method of puncturing.