心包腔容积—压力关系的临床研究

The study of pericardial volume pressure relationship in patients with pericardial effusion

１６ 例中到大量心包积液患者在Ｘ线下使用Ｓｅｌｄｉｎｇｅｒ法，经剑突下穿刺心包放置７Ｆ导鞘，心包造影，定量抽液及压力测定。资料完整的１５ 例患者显示：心包腔内压力与心包积液量无相关性。有心包填塞症状者，当抽液量达到１５０ ｍ ｌ时，心包内压力下降曲线最为陡峭：幅度最大，而以后随积液量减少，压力下降徐缓。当抽液到２５０ ｍ ｌ时心包腔舒张压在０．４０ ｋＰａ～－ １．４６ ｋＰａ 之间，大多数低于文献报道的右房舒张压。在积液基本抽完时，１２ 例心包腔平均压在０～－ １．３３ ｋＰａ之间，最低可达－ ２．０ ｋＰａ，与胸膜腔压近似。１ 例有肺气肿的老年患者和２ 例有胸腔积液者压力在０．１３ ｋＰａ～０．５３

There were 16 patients with medium to large volumes of pericardial effusion in this study. Using the Seldinger technigue,a 7 French sheath tube,in the xiphocoastal puncture approach,was introduced, under fluroscopic guidance,into the pericaridal space for drawing effusion,measuring pressure and pericardiography. Fifteen patients finished the trial. The results showed there was no correlation in the pericardial volume pressure relationship. In the patients with cardiac tamponade,the pericardial pressure tracings decreased sharply when 150 ml of effusion was removed. After this,following continual aspiration,the pericardial pressure decreased slowly. When 250 ml of effusion was removed,the pericardal diastolic pressure was significantly lower than the right atrial diastolic pressure. When the pericardial effusion was nearly completely removed,the average pericardial pressure was between 0 kPa^1.33 kPa in 12 patients,the lowest being -2.0 kPa, which was similar to the pleural pressure. The pericardial pressures of the three patients,one with pulmonary emphysema and the other two with pleural effusion,were 0.13 kPa^0.53 kPa.