中心静脉置管导致早产儿心包积液的临床分析

A clinical analysis of pericardial effusion caused by central venous catheterization in preterm infants

目的探讨早产儿中心静脉置管导致心包积液的临床特征。方法回顾性选择发生中心静脉置管相关心包积液的11例早产儿为研究对象,分析其置管特征、表现、治疗及预后。结果中心静脉置管相关心包积液发生率为0.42%(11/2599)。11例心包积液患儿的平均胎龄(30.1±2.6)周,平均出生体重(1240±234)g。心包积液多发生于中心静脉导管置入后4 d内(10例,91%),主要表现为反应差(6/11,55%)、呼吸增快(6/11,55%)、心率增快(6/11,55%)、发绀(5/11,45%)、呼吸困难加重(5/11,45%)、心音低钝(5/11,45%)等。发生心包积液时管端过深7例(64%),位置正确3例(27%),管端过浅1例(9%)。5例患儿(45%)发生心包填塞,其中4例行心包穿刺;7例患儿仅予内科保守治疗。2例(18%)死亡,9例(82%)好转。结论中心静脉置管导致心包积液多发生于置管早期,临床表现危重,合并心包填塞需行心包穿刺治疗,早期诊断干预可有效改善预后。

Objective To study the clinical features of pericardial effusion caused by central venous catheterization in preterm infants.Methods A retrospective analysis was performed on 11 preterm infants with pericardial effusion caused by central venous catheterization.Their catheterization features,manifestations,treatment,and prognosis were analyzed.Results A total of 11 preterm infants(11/2599,0.42%)developed pericardial effusion,with a mean gestational age of(30.1±2.6)weeks and a mean birth weight of(1240±234)g.Pericardial effusion mostly occurred within 4 days after central venous catheterization(10 cases,91%).The main manifestations included poor response(6/11,55%),cyanosis(5/11,45%),increased respiratory rate(6/11,55%),increased heart rate(6/11,55%),aggravated dyspnea(5/11,45%),and muffled heart sound(5/11,45%).At the time of disease progression,7 preterm infants(64%)had a deep position of the end of the catheter,3 preterm infants(27%)had a correct position,and 1 preterm infant(9%)had a shallow position.Five preterm infants(45%)experienced cardiac tamponade,among whom 4 underwent pericardiocentesis.Seven preterm infants were given conservative medical treatment.Among the 11 children,2(18%)died and 9(82%)improved.Conclusions Pericardial effusion caused by central venous catheterization mostly occurs in the early stage of catheterization and has critical clinical manifestations.Pericardiocentesis is required for cardiac tamponade,and early diagnosis and intervention can effectively improve prognosis.