心包积液持续导管引流穿刺部位的新选择

The new choice of pericardiocentesis route for percutaneous indwelling catheter drainage in patients with pericardial effusion

目的 探讨经胸骨左缘第 3、4肋间穿刺放置心包积液引流导管的可行性和安全性。方法 应用二维超声心动图 ( 2DE) ,探测 38例中到大量心包积液患者剑突下、心尖部及胸骨左缘第 3、4肋间距胸骨左缘 2cm处 3个部位的舒张期最大积液厚度和预定进针深度 ;在 2DE引导下 ,以胸骨左缘第 3、4肋间为穿刺点 ,留置导管引流心包积液。结果 2DE探测 3个部位的舒张期最大积液厚度差异无显著性 ,胸骨左缘第 3、4肋间处预定进针深度最小 ;38例患者均一次穿刺、留置导管成功 ,其中36例 ( 94 8% )经超声证实引流导管位于后心包。无穿刺相关并发症 ,无导管脱出心包腔及积液渗漏至胸腔或皮下 ,1例于放置引流导管后第 3天发生神经介导性晕厥。结论 经胸骨左缘第 3、4肋间途径行心包引流导管留置术安全有效、操作简便 。

Objective To investigate the efficacy and safety of percutaneous pericardial drainage with indwelling catheter via the puncturing route of left sternal broader in the third or fourth interspace Methods In the 38 patients with moderate to large pericardial effusion, the pericardial echo free space and the forecasted puncturing distance were measured with two dimensinal echocardiolgraphy (2DE) prior to pericardiocentesis in the three sites: subxiphoid, cardiac apex and the left sternal broader in the third or fourth interspace Under the guidance of 2DE, pigtail catheters were percutaneously indwelled for pericardial drainage via the location of left sternal broader in the third or fourth interspace Results Among the three sites, there were no difference of echo free space measured by 2DE, and the forecasted distance of advancing needle examined in left sternal broader was the smallest The procedures of indwelling catheter drainage for pericardial effusion were successfully performed in all the 38 patients Catheters lying in posterior pericardium were found in 94 8% of the patients (36/38) There were no cases with puncturing related complications, effusion leaking into pleurum or subcutaneous tissue Only 1 case was complicated with neural mediated syncope on the third day after indwelling catheter Conclusion Pericardiocentesis using left sternal broader route is a safe and simple approach for indwelling catheter drainage in patients with pericardial effusion This route may be a promising option for clinical use widely