与心血管介入相关的心包填塞17例临床分析

摘要

目的:总结17例与心血管介入相关的心包填塞病例资料.方法:17例患者均表现为心血管介入术后血压急剧下降、心率增快、颈静脉充盈及奇脉.分析其病因:5例为经皮冠状动脉介入治疗中冠状动脉破裂;1例阵发性室上性心动过速射频消融患者因冠状静脉窦电极插入过深导致其破裂;1例心房扑动和5例心房颤动患者为射频消融损伤左心房;3例行植入永久性心脏起搏器术患者为操作导致;2例由临时心脏起搏电极引起右心室穿孔的心包填塞.17例患者均给予急诊X线透视心包超声检查以明确诊断,有效的治疗手段为立即床边心包穿刺引流,同时辅以静脉扩容与药物升血压治疗.结果:17例患者中心包引流物为200～2000 ml不等,4例患者给予静脉输血.5例经皮冠状动脉介入治疗患者立即停用肝素等抗凝药物,3例患者还给予鱼精蛋白中和肝素,2例给予补充血小板.15例患者经保守治疗后好转,2例患者进行了胸外手术治疗,所有患者无一例死亡.结论:介入相关的心包填塞贵在早认识、早发现,心包穿刺引流是有效的治疗手段.%Objective: To summarize the clinical experience of pericardial tamponade caused by different cardiovascular interventional procedures in 17 patients.Methods: All patients suffered from hemodynamic collapse, tachycardia and jugular venous distension right after the interventional procedures The etiological reasons included coronary artery perforation, atrial fibrillation ablation or atrial flutter ablation caused chamber perforation, electrophysiology and improper pacemaker insertion caused impairment of coronary sinus. All patients had emergent X-ray examination and echocardiography to confirm the diagnosis.Results: The effective treatment was immediate bedside pericardiocentesis and meanwhile, using the hydration and necessary medication to raise blood pressure. The amount of fluid by pericardiocentesis was 200 ～ 2000ml from different patient respectively. 4 patients received blood transfusion,5 patients with percutaneous coronary intervention stopped taking heparin,2 patients received the supplement platelet transfusion. Overall, 15 patients recovered with expectant treatment and 2 underwent emergent chest surgery, no body died.Conclusion: Early diagnosis is essential for patients with pericardial tamponade caused by different cardiovascular interventional procedure,and pericardiocentesis is an effective treatment.