心脏介入性治疗并发心脏压塞的处理策略

Management of cardiac tamponade during cardiac interventional procedure

目的 探讨心脏介入治疗并发心脏压塞的处理策略。方法 12例心脏压塞患者 ,男性 5例 ,女性 7例 ,年龄 2 8～ 5 2岁。其中经皮二尖瓣球囊扩张术 8例 ,冠状动脉腔内成形术 1例 ,先天性动脉导管未闭封堵术 2例 ,右心室起搏 1例。根据心脏穿孔的不同原因、可能的部位及心脏压塞情况 ,分别采用心包穿刺引流、心包穿刺引流与开胸修补或开胸置管引流等方法治疗。结果 3例单纯心包穿刺引流均痊愈 ;8例紧急心包穿刺引流后开胸修补有 7例痊愈 ,1例主动脉根部破裂者因心源性休克时间过长 ,死于呼吸衰竭 ;1例冠状动脉腔内成形术者左回旋支穿孔 ,紧急心包穿刺引流后心包切开、胸腔置管引流痊愈。结论 根据心脏介入性治疗导致心脏压塞的不同原因、可能部位及心脏压塞进展情况 ,采取相应措施 ,可有效治疗此类并发症。

Objective To explore the management of cardiac tamponade during or after cardiac interventional procedure.Methods Twelve patients with cardiac tamponade (including 5 men and 7 women,age from 28 to 52.PBMV 8,PTCA 1,closure of PDA 2 and right ventricular pacing 1) during or after cardiac interventional procedure were treated with simple pericardial puncture and drainage,combining with pericardium repair through thoracotomy or drainage through inserting catheter in thoracic cavity respectively according to the cause,position and speed of cardiac tampanade.Results Three patients with cardiac tamponade were healed by simple pericardial puncture and drainage.In 8 patients who were carried out emergency pericardial puncture,drainage and combined mending pericardium through thoracotomy,7 patients throughly recovered and 1 patient died of respiratory failure because the time of cardiac shock was too long.One patient whose left circumflex coronary artery ruptured in percutaneous transluminal coronary angioplasty recovered by pericardiectomy and inserting drainage-tube in thoracic davity after emergency pericardial puncture and drainage.Conclusion Cardiac tamponade complicating interventional cardiology might be cured effectively by corresponding therapy according to its cause,position and speed.