心脏介入治疗合并急性心包填塞的识别与处理(摘要)
作者：马长生 张晓 王勇 颜红兵 周玉杰 陈良龙 钟敬泉 刘兴鹏 李宪伦
单位：北京市，中日友好医院 心内科(100029)
关键词：
目的 目的：急性心包填塞是心脏介入治疗严重并发症之一。本文分析心脏介入治疗时急性心包填塞的诊断与处理。
方法：本组8例急性心包填塞患者，占同期各种心脏介入治疗病例的2.1%(8/3 815)。诊断方法：介入性治疗中患者突然出现烦躁、意识淡漠、血压明显下降、心率突然变慢、X线心脏搏动减弱伴心影扩大，在排除其他原因后即可诊断。处理方法：患者取平卧位，用18号静脉穿刺针带注射器及造影剂，在X线透视下于剑突下进行心包穿刺。穿刺针进入心包后立即注射5 ml造影剂，若造影剂沿心包分布则肯定穿刺针入心包。然后送入145 cm导引钢丝，并经钢丝送入鞘管及猪尾导管。引流完毕后留置猪尾导管24小时。同时通知外科手术组作好准备以便应急。
结果：所有患者均得到及时诊断，心包穿刺均获得成功，引流效果满意。所有患者均未经外科进一步处理。
结论：心脏介入治疗时的急性心包填塞临床表现具有特征性。一旦明确诊断，积极穿刺引流是首选的治疗方法。X线透视与造影剂指示下心包穿刺引流是一种快速、安全、准确、值得推广的方法。心脏外科的支持是多数心脏介入治疗必不可少的条件。
Identification and Treatment of Acute Cardiac Tamponade during Cardiac Intervention (Abstract)
Department of Cardiology, China-Japan Friendship Hospital, Beijing (100029)
Ma Changsheng, Zhang Xiao, Wang Yong, et al.
Objective: Acute cardiac tamponade is a serious complication in interventional cardiology. Diagnosis and treatment of acute cardiac tamponade during cardiac intervention were reported.
Methods: Eight cases with cardiac tamponade were diagnosed according to the followings: mania, low blood pressure, bradycardia and cardiac enlargement under flouroscopy.Once correctly recognized, pericardiocentesis started via subxyphid routine under flouscopy, including insertion of 145 cm guide wire, sheath and pigtail catheter. Surgery was informed for emergency.
Results: All patients had correct diagnosis and treatment without further surgical intervention.
Conclusion: Pericardiocentesis is the method of first choice once characterastic acute cardiac tamponade during cardiac intervention was diagnosed. Pericardiocentesis is a fast, safe, accurate and popular choice under the guideline of flouroscopy and contrast medium. The support of surgery is essential during cardiac intervention., http://www.100md.com
单位：北京市，中日友好医院 心内科(100029)
关键词：
目的 目的：急性心包填塞是心脏介入治疗严重并发症之一。本文分析心脏介入治疗时急性心包填塞的诊断与处理。
方法：本组8例急性心包填塞患者，占同期各种心脏介入治疗病例的2.1%(8/3 815)。诊断方法：介入性治疗中患者突然出现烦躁、意识淡漠、血压明显下降、心率突然变慢、X线心脏搏动减弱伴心影扩大，在排除其他原因后即可诊断。处理方法：患者取平卧位，用18号静脉穿刺针带注射器及造影剂，在X线透视下于剑突下进行心包穿刺。穿刺针进入心包后立即注射5 ml造影剂，若造影剂沿心包分布则肯定穿刺针入心包。然后送入145 cm导引钢丝，并经钢丝送入鞘管及猪尾导管。引流完毕后留置猪尾导管24小时。同时通知外科手术组作好准备以便应急。
结果：所有患者均得到及时诊断，心包穿刺均获得成功，引流效果满意。所有患者均未经外科进一步处理。
结论：心脏介入治疗时的急性心包填塞临床表现具有特征性。一旦明确诊断，积极穿刺引流是首选的治疗方法。X线透视与造影剂指示下心包穿刺引流是一种快速、安全、准确、值得推广的方法。心脏外科的支持是多数心脏介入治疗必不可少的条件。
Identification and Treatment of Acute Cardiac Tamponade during Cardiac Intervention (Abstract)
Department of Cardiology, China-Japan Friendship Hospital, Beijing (100029)
Ma Changsheng, Zhang Xiao, Wang Yong, et al.
Objective: Acute cardiac tamponade is a serious complication in interventional cardiology. Diagnosis and treatment of acute cardiac tamponade during cardiac intervention were reported.
Methods: Eight cases with cardiac tamponade were diagnosed according to the followings: mania, low blood pressure, bradycardia and cardiac enlargement under flouroscopy.Once correctly recognized, pericardiocentesis started via subxyphid routine under flouscopy, including insertion of 145 cm guide wire, sheath and pigtail catheter. Surgery was informed for emergency.
Results: All patients had correct diagnosis and treatment without further surgical intervention.
Conclusion: Pericardiocentesis is the method of first choice once characterastic acute cardiac tamponade during cardiac intervention was diagnosed. Pericardiocentesis is a fast, safe, accurate and popular choice under the guideline of flouroscopy and contrast medium. The support of surgery is essential during cardiac intervention., http://www.100md.com