心包腔内注入凝血酶治疗经皮冠状动脉介入治疗围术期急性心脏压塞的疗效和体会(附13例)

Intra-pericardial thrombin injection for acute cardiac tamponade during percutaneous coronary intervention

目的 探讨冠心病经皮冠状动脉介入治疗（PCI）并发冠状动脉穿孔致急性心脏压塞的临床特征、处理方法,以提高抢救成功率。方法 回顾性分析2005年1月至2015年12月在新疆维吾尔自治区人民医院心内科住院行PCI时并发冠状动脉穿孔导致急性心脏压塞的冠心病患者13例,分析发生原因、临床表现、处理方法及预后。结果 所有患者均得到及时诊断,心包穿刺均获得成功,心包腔内注入凝血酶冻干粉500～1000 U得到有效止血,术后2 h、4 h、6 h、24 h及出院前复查心脏超声未发现新的心包积液及心包粘连。所有患者出院后6个月随访心脏超声未见心包缩窄或粘连。结论 急性心脏压塞是PCI术中严重的并发症之一,一旦诊断明确,需紧急心包穿刺引流。心包腔内注入凝血酶能成功止血,提高抢救成功率。

Objective To explore the diagnosis and management of acute cardiac tamponade for coronary artery perforation during cardiac intervention. Methods This is a retrospective study looking into the cause, clinical presentations and the outcome of acute cardiac tamponade in 13 patients during PC! between 2005.01 to 2015.12. Results The diagnosis of intraoperative cardiac tamponade was made clinically with acute onset of symptoms and was confirmed by echocardiography and bloody drainage from acute pericardiocentesis. Tamponade was relieved in all 13 patients by urgent pericardiocentesis. Following the aspiration of all pericardial fluid, we injected 500 - 1000 units of thrombin into the pericardial cavity and intravenous injection of protamine for heparin reversal. All 13 patients were discharged without need of further surgical intervention. Echocardiographic follow-up up to 6 months after discharge did not show recurrence of pericardial effusion or pericardial constriction. Conclusions Acute cardiac tamponade is a serious complication in interventional cardiology. Once correctly recognized, emergency pericardiocentesis is an effective treatment and intra-pericardial thrombin injection can enhance hemostasis and clinical outcome.