心脏直视手术后延迟性心脏压塞的诊治体会

目的 总结心脏直视手术后延迟性心脏压塞（delayed cardiac tamponade,DCT）的诊治经验。方法 4例在四川省人民医院接受心脏直视手术治疗的患者分别于术后7∽85 d发生DCT。1例行心包穿刺抽液治疗,1例行原切口剑突下切开引流治疗,2例经原切口开胸行廓清手术治疗。结果 4例均痊愈出院,心功能恢复至Ⅰ级,随访心脏彩超提示心包腔内无明显积液和积血。结论 DCT可致严重后果,一旦确诊,应及早手术治疗。对接受心脏直视手术的患者术后应严密观察,预防DCT的发生。

Objective To summarize the diagnosis and surgical treatment experience of delayed cardiac tamponade （DCT） after open-heart surgery.Methods 4 patients with cardiac disease undergone open-heart surgery developed DCT from 7 to 85 days postoperatively. Pericardial puncture by echocardiogram guiding was effective in pumping liquid in 1 patient, incision and drainage was performed by small subxiphoid incision of original incision in 1 patient, thoracic exenteration was performed by original incision in 2 patients.Results All 4 patients were cured and discharged. Cardiac function recovered to grade I. Obvious effusion and hematocele were not found in cavum pericardii by echocardiogram during following-up period.Conclusion DCT can cause severe consequences. Once DCT was diagnosed, surgical treatment should be performed as soon as possible. Close observation should be given to patients undergone open-heart surgery for preventing the occurrence of DCT.