经外周静脉穿刺中心静脉置管相关新生儿心包积液/心脏填塞2例并文献复习

Neonatal pericardial effusion/cardiac tamponade related to peripherally inserted central catheters:two case reports and literature review

目的探讨经外周静脉穿刺中心静脉置管(peripherally inserted central catheter,PICC)相关新生儿心包积液/心脏填塞的临床特点、治疗及预后。方法回顾性分析2019年10月和2021年2月四川省医学科学院·四川省人民医院(电子科技大学附属医院)收治的2例PICC相关心包积液/心脏填塞新生儿的临床资料。以“中心静脉置管”“深静脉置管”“心包积液”“心脏填塞”和“新生儿”为关键词,检索中国知网、万方数据库、中华医学期刊全文数据库和维普数据库;以“peripherally inserted central catheter”“central venous catheter”“pericardial effusion”“cardiac tamponade”和“neonate”为关键词,检索PubMed、Web of Science和Embase数据库。检索从建库至2023年6月收录的文献。总结PICC相关心包积液/心脏填塞新生儿的临床特点、治疗及预后。采用描述性统计分析,并采用Fisher精确概率法比较不同治疗方式对患儿预后的影响。结果(1)病例资料:2例患儿均表现为突发心率、氧饱和度下降,呼吸困难,面色苍白,口唇发绀;病例1未行心包穿刺,病例2行心包穿刺。2例患儿均死亡。(2)文献复习:共检索到25篇文献(中文6篇,英文19篇),共45例患儿;连同本单位的2例,共47例患儿。①47例中,44例(94%)为早产儿,3例(6%)为足月儿;46例患儿胎龄(29.5±3.9)周,1例足月儿未报告具体胎龄。46例患儿出生体重(1227±600)g,其中43例(91%)为低出生体重儿。②9例(19%)未说明PICC置入部位;32例(68%)从上肢置入,6例(13%)从下肢置入。出现心包积液/心脏填塞症状后,26例(55%)导管尖端位于或接近右心房,3例(6%)位于腔静脉与右心房交界处,3例(6%)位于心包腔内或心脏轮廓内,2例(4%)位于上腔静脉,1例(2%)位于肺动脉,1例(2%)位于左心房,1例(2%)位于右心室。10例(21%)未说明具体位置。③47例中的13例(28%)发生导管漂移,11例(23%)发生导管弯折或成角。④47例中,30例(64%)行心包穿刺术,1例(2%)行心包切开术;16例(34%)行保守治疗。⑤非保守治疗组(行心包穿刺或心包切开术)治愈率为81%(25/31),高于非保守治疗组(6/16)(Fisher精确概率法,P=0.004)。结论如PICC置管术后患儿突发血流动力学或呼吸异常,应积极完善心脏超声检查明确诊断,并及时行心包穿刺术,以提高存活率。

ObjectiveTo examine the clinical characteristics,treatment,and prognosis of peripherally inserted central catheter(PICC)-related pericardial effusion/cardiac tamponade in neonates.MethodsA retrospective analysis was conducted on the clinical data of two neonates with PICC-related pericardial effusion/cardiac tamponade admitted to Sichuan Academy of Medical Sciences&Sichuan Provincial People's Hospital(School of Medicine,University of Electronic Science and Technology of China)between October 2019 and February 2021.Literature was searched using keywords"peripherally inserted central catheter","central venous catheter","deep venous catheter","pericardial effusion","cardiac tamponade",and"neonate"in databases including CNKI,Wanfang,Yiigle,VIP Database,PubMed,Web of Science,and Embase databases up to June 2023.Clinical characteristics,treatment,and prognosis of neonates with PICC-related pericardial effusion/cardiac tamponade were summarized.Descriptive statistical analysis was used,and Fisher's exact test was employed to compare the impact of different treatment methods on the prognosis of the infants.Results(1)Case report:Both infants experienced sudden onset of decreased heart rate and oxygen saturation,respiratory distress,pallor,and cyanosis of the lips.Case 1 did not undergo pericardiocentesis,while Case 2 did.Both infants died.(2)Literature review:A total of 25 articles(six in Chinese and 19 in English)were retrieved,involving 45 infants.Including the two cases from our institution,there were 47 infants in total.Among the 47 infants,44(94%)were preterm,and three(6%)were full-term.The gestational age of 46 infants was(29.5±3.9)weeks,with one full-term infant not reporting a specific gestational age.The birth weight of 46 infants was(1227±600)g,with 43(91%)being low birth weight infants.Nine cases(19%)did not specify the insertion site;32 cases(68%)had the catheter inserted from the upper limb and six cases(13%)from the lower limb.After the onset of pericardial effusion/cardiac tamponade symptoms,the catheter tip was located at or near the right atrium in 26 cases(55%),at the junction of the vena cava and right atrium in three cases(6%),within the pericardial cavity or cardiac silhouette in three cases(6%),in the superior vena cava in two cases(4%),in the pulmonary artery in one case(2%),in the left atrium in one case(2.1%),and in the right ventricle in one case(2%).Ten cases(21%)did not specify the exact location.Among the 47 cases,13(28%)experienced catheter migration,and 11(23%)had catheter kinking or angulation.Thirty cases(64%)underwent pericardiocentesis,one case(2%)underwent pericardiotomy,and 16 cases(34%)received conservative treatment.The cure rate in the non-conservative treatment group(pericardiocentesis or pericardiotomy)was 81%(25/31),higher than that in the conservative treatment group(6/16)(Fisher's exact test,P=0.004).ConclusionOnce sudden hemodynamic or respiratory abnormalities occur,cardiac ultrasound should be promptly performed to confirm the diagnosis,and pericardiocentesis should be timely conducted to improve the survival rate of the neonates.