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 drainage of pericardial catheter intervention in diagnosis and treatment of acute cardiac tam-ponade

目的：探讨心脏介入术并发急性心包填塞诊治中超声引导下心包置管引流的应用价值。方法本次选取临颍县人民医院2012年5月至2014年5月收治的心脏介入术并发急性心包填塞患者40例，采用超声引导下心包置管引流治疗，回顾分析临床资料。结果本研究患者均在超声引导下行抽吸术或置管引流术，均置管成功，摘出100～800 ml不凝固鲜红色血液，中心静脉导管行8～72 h留置。临床升压、静脉补液、输血等抢救治疗后，心包填塞出血停止39例，迅速缓解心脏压迫症状，另1例经诊断示为风湿性心瓣膜病，采用经皮左房室瓣球囊成形术，有急性心包填塞发生，实施紧急手术，成功置管后，因患者年龄大，出血量大，心功能差，抢救无效死亡。对痊愈患者随访，无心包肥厚和缩窄性心包炎发生。结论针对心脏介入术后有急性心包填塞并发的患者，在超声引导下行心包置管引流，可发挥治疗、穿刺作用，风险低，损伤小，费用低，操作简便，在临床有较高应用价值，值得在临床广泛推广应用。

Objective To investigate the effect of ultrasound guidance pericardial catheter drainage on acute cardi-ac tamponade.Methods From May 2012 to May 2014, Forty patients with acute cardiac tamponade in our hospital were treated by pericardial catheter drainage under ultrasound-guided therapy, the clinical data were retrospectively analyzed. Results The patients had ultrasound guided aspiration or downstream drainage catheter, catheter were successfully pick out 100-800 ml red blood without coagulation, 8-72h indwelling central venous catheter.After clinical boost, intravenous fluids, blood transfusions and other emergency treatment, bleeding stopped in 39 cases of cardiac tamponade, the symptoms of heart oppression rapidly relieved.The other one case was diagnosed as wet valvular heart disease, left atrioventricular valve using percutaneous balloon angioplasty, and acute cardiac tamponade occurred, emergency surgery, after a successful catheter, because of high patients, large bleeding volume and poor heart function the case died.Patients were followed up for recovery, centerless package hypertrophy and constrictive pericarditis.Conclusions For cardiac interventional postop-erative patients with acute cardiac tamponade, ultrasound guided pericardial catheter drainage can play a therapeutic punc-ture effect with the advantages of low-risk, low damage, low cost, easy to operate, there is high clinical value, it is worth clinical application.