心脏介入性手术中心脏压塞发生的原因、处理及预后

The cause,management and prognosis of cardiac tamponade during interventional procedures

目的 报道因心脏介入手术所致的 12例心脏压塞病例 ,分析其可能原因、临床表现及治疗结果 ,随访其预后。方法 5 0 4 0例心脏介入手术中共发生 12例心脏压塞 ,男性 4例 ,女性 8例 ,平均年龄 (5 6± 17)岁 ,其中 8例与导管标测和射频消融术有关 ,2例与经皮冠状动脉腔内成形术有关 ,2例与先天性心脏病介入治疗有关。结果 心脏压塞的主要原因包括左心室穿孔、心脏静脉破裂、冠状动脉和左心耳穿孔。 8例经立即心包穿刺抽液 15 0～ 10 0 0ml病情稳定 ,4例因出血量大进行了外科手术。出院后平均随访 (2 3 6± 13 1)个月 ,全部病人情况良好。结论 心脏压塞是心脏介入治疗过程中严重的并发症 ,及时发现和有效处理十分重要。

Objective To report 12 cases of cardiac tamponade caused by interventional procedures,analyze the probable cause,and observe the clinical manifestation,the result of the emergency management and follow-up.Methods Out of 5 040 patients underwent interventional procedures,twelve had cardiac tamponade.There were 4 men and 8 women with mean age of (56±17) years.Eight of the 12 patients were caused by catheter mapping and radiofrequency catheter ablation,2 by PTCA and 2 by transcatheter ASD closure.Results Hemodynamics was stable in 8 cases after successful pericardiac puncture with 150～1 500 ml drainage.Surgical repair was needed in the rest 4 patients because of the massive bleeding.All patients are free of any symptom after a mean follow-up of (23.6±13.1) months.Conclusion Cardiac tamponade is one of the most serious complications during interventional cardiac procedures.Early diagnosis and immediate proper management are very important.