超声引导下心包置管引流在心脏介入术并发急性心包填塞诊治中的应用

Ultrasound-guided Pericardial Catheter Drainage in Diagnosis and Treatment of Acute Cardiac Tamponade Accompanied by Cardiac Intervention

目的探讨超声引导下心包置管引流在心脏介入术中并发急性心包填塞的应用价值。方法对本院30例在介入术中并发的由超声心动图或X线透视证实的急性心包填塞患者的临床资料进行回顾性分析。结果我院1986年12月—2009年6月开展心脏介入治疗7000例患者,共有30例发生急性心包填塞,发生率为0.43%。30例患者在心脏介入治疗术中出现胸闷、气促、心悸、呼吸困难、血压降低,或呼吸心搏骤停、昏迷等。均经床旁超声心动图或X线透视检查证实心包腔积液。17例发生于经皮左房室瓣球囊成形术,死亡4例;5例发生于冠状动脉成形及支架术中,死亡1例;8例发生于射频消融术中(其中6例发生于阵发性房颤射频消融术中;2例发生在室上性心动过速射频消融术中,其中1例合并甲状腺功能低下)。紧急实施经皮seldinger法在剑突下穿刺心包腔及置管引流术,抽出心包腔不凝固鲜红色血液100～800ml,平均(540.5±220.6)ml,猪尾巴导管留置时间8～24h,平均(18.5±5.5)h。经快速补液、输血和多巴胺升压等治疗后,19例自愈;6例经心包腔穿刺持续引流大量积血,送胸外科行急诊开胸心肌修补术或海绵填塞止血,症状逐渐缓解而痊愈出院;5例死亡。结论急性心包填塞是心脏介入诊疗过程中严重的并发症,及时发现和有效处理非常重要,超声引导下经皮穿刺心包置管引流是治疗急性心包填塞的有效方法。

Objective To investigate the application of ultrasound-guided pericardial drainage in diagnosis and treatment of acute cardiac tamponade complications in cardiac interventional treatment.Methods Clinical data of 30 patients with acute cardiac tamponade complications in interventional procedures,confirmed by echocardiogram or X-ray,were analyzed retrospectively.Results A total of 7 000 patients underwent cardiac interventional treatment,and 30 had acute cardiac tamponade（0.43%）,presenting with dyspnea,short breath,palpitation,dyspnea,decreased blood pressure,or apnea and cardiac arrest,coma,etc.,confirmed as pericardial effusion by bedside echocardiogram or X-ray.17 had it in percutaneous balloon mitral valvuloplasty in 17 patients,4 died;5 in coronary angioplasty and tenting,1 died;8 in radiofrequency catheter ablation（6 died in radiofrequency ablation for paroxysmal AF）;2 in radiofrequency ablation for supraventricular tachycardia,1 complicated by hypothyroidism.Seldinger method was used urgently to perform pericardial cavity puncture and drainage,and abstract non-coagulating bright red blood 100～800 ml,averaging（540.5±220.6）ml,and the indwelling time of pigtail catheter was 8～24 h,averaging（18.5±5.5）h.After rapid rehydration,blood transfusion and pressure boosting with dopamine,19 self-cured;6 sent to department of thoracic surgery to have emergency myocardial repaire or hemostasia by sponge and then relieved gradually to be discharged;5 died.Conclusion Acute cardiac tamponade is a severe complication in interventional treatment.Timely detection and effective treatment is very important.Ultrasound-guided percutaneous pericardial drainage is an effective method for acute tamponade.