持续性心包引流合并症的探讨

Complications of pericardiocentesis and drainage for pericardial effusion

目的 持续性心包穿刺引流是治疗大量心包积液和心包填塞的常用方法,本文旨在探讨心包穿刺引流的合并症。方法 本文对5例发生了心包穿刺引流合并症的住院患者进行分析。结果 在5例合并症中,有2例因导管前端刺激发生神经介导性晕厥,1例发生急性右心室扩张并死亡,1例发生心包积液经导管管侧孔漏入左侧胸腔,1例出现急性肺水肿和心包积液经穿刺处漏入皮下组织。结论 应充分认识持续心包引流所引起的血流动力学改变,对危重患者应行床旁血流动力学监测。同时应注意引流导管本身对患者可能造成的损伤。

Objective Pericardiocentesis and drainage are the common measures for the treatment of cardiac temponade and massive pericardial effusion. In this issue, the complications of pericardiocentesis and drainage were discussed. Methods 5 in-hospital cases of cardiac temponade or massive pericardial efiusion who had complications of pericardiocentesis and drainage were reported and analyzed. Results The complications were 2 cases with neural mediated syncope, 1 case with pleural efiusion, 1 case dead of acute right ventricular dilation, and 1 case with acute pulmonary edema and effusion leaking into the subcutaneous tissue. Conclusion The importance of hemodynamic change during pericardiocentesis and drainage could not be over-emphasized, and the patients whose hemodynamic status were unstable should be monitored by bedside hemodynamic monitoring or echocardiography. Also we should pay more attention to the drainage catheter per se, which may cause the complications.