针灸后出现心包积液并发急性心脏压塞患者一例

A Case of Pericardial Effusion Complicated with Acute Cardiac Tamponade After Acupuncture and Moxibustion

总结1例针灸后出现心包积液并发急性心脏压塞患者的急救和护理。患者因诊所行针灸治疗,于剑突下行针灸时出现胸闷、心慌、头晕、头痛等不适症状。于外院诊断为“心包积液”,行心包穿刺引流术后症状未缓解,遂转入大连理工大学附属中心医院急诊科进一步治疗。入院后患者诉胸闷、心慌,伴头晕、头痛,躁动不安,呼吸急促,面色苍白,口唇发绀,左上肢及前胸部可见皮下花斑,四肢末梢湿冷。心脏超声示心包腔内见微量液性暗区;胸腹主动脉CT血管造影示心脏饱满,心包积液(血性)。经紧急抢救,抗休克、补液、升压等对症治疗,在超声引导下行心包穿刺引流术,严密监测患者生命体征及心包穿刺后引流管护理,积极配合抢救治疗。5 d后患者临床症状消失,拔除引流管后出院。出院后日常活动无不适。

To summarize the first aid nursing care of a patient with pericardial effusion complicated with acute cardiac tamponade after acupuncture and moxibustion.The patient suffered from chest tightness,palpitation,dizziness,headache and other uncomfortable symptoms when acupuncture and moxibustion was performed at the xiphoid process.Diagnosed as"pericardial effusion"in an external hospital,the symptoms did not improve after pericardial puncture and drainage surgery,so he was transferred to Emergency Department,the Affiliated Central Hospital of Dalian University of Technology for further treatment.After admission,the patient complained of chest tightness,palpitations,accompanied by dizziness,headache,restlessness,shortness of breath,pale complexion,cyanosis of the lips,subcutaneous freckles visible in the left upper limb and anterior chest,and damp and cold limbs.Cardiac ultrasound shows a trace of liquid dark areas in the pericardial cavity;CTA of the thoracic and abdominal aorta shows a plump heart with pericardial effusion(bloody).After emergency rescue,targeted treatment such as anti-shock,fluid replacement,and pressure boosting,pericardial puncture and drainage under ultrasound guidance were performed.The patient's vital signs were closely monitored and the drainage tube care after pericardial puncture was taken,and active cooperation was provided for rescue and treatment.After 5 days,the patient's clinical symptoms disappeared and was discharged after removing the drainage tube.No discomfort in daily activities after discharge.