心房扑动射频消融术致心包填塞合并迟发性腹腔内大出血1例

Pericardial tamponade with delayed inter-abdominal hemorrhage caused by atrial flutter ablation: a case report

报道心房扑动患者行射频消融术中突发心脏破裂、心包填塞,行紧急心包穿刺引流、开胸止血及心脏修补术后发生迟发性腹腔内大出血1例。心包填塞病死率高、风险大,应用经食管超声可以帮助判断心包内出血量,维持循环稳定及保证止血效果。心包填塞后发生迟发性腹腔内出血十分罕见,易漏诊、误诊。术后结合经食管超声及床旁超声检查,可以尽早排除二次心包填塞,及时发现迟发性腹腔内出血。麻醉医师及ICU医师掌握超声监测技术对处理危重急症患者具有重要意义。

A patient suffered from cardiac rupture and pericardial tamponade during atrial flutter ablation and then treated with emergent pericardiocentesis and thoracotomy for repairing the cardiac injury. Pericardial tamponadehas a high mortality. Tansesophageal echocardiography can be adopted to determine the volume of blood in the pericardium and the effect of hemostasis, as well as maintain circulation stability. Delayed abdominal hemorrhage after pericardial tamponade is rare which is usually missed diagnosed and misdiagnosed. Combined with transesophageal echocardiography and bedside ultrasonography, the secondary pericardial tamponade can be excluded as early as possible. It is of great significance for anesthesiologists and intensive care unit (ICU) doctors to master the ultrasonic monitoring technique.