探讨心脏介入性治疗中并发心脏压塞的原因及诊断治疗

摘要

Objective:To investigate the reasons,diagnosis and treatment methods of cardiac tamponade in treatment of cardiac interventional therapy. Method:The clinical data of 487 patients with cardiac interventional therapy in hospital the were selected from January 2010 to November 2014,the cardiac tamponade was diagnosed by clinical manifestations, echocardiography and X-ray examination.Once found patients with cardiac tamponade,immediately stop cardiac interventional therapy,they were given pericardiocentesis drainage,pericardial incision and drainage in the treatment of surgery,coronary artery bypass surgery and repair of coronary artery.Result:487 patients in our hospital with cardiac interventional therapy occurred in 3 cases of cardiac tamponade complications,the incidence was 0.62%. The incidence of reason:atrial septal mistaken puncture into the left atrial wall,left atrial wall damage,coronary artery rupture and pericardial tamponade.2 patients had disease by X-ray examination confirmed,another 1 cases of patients with X-ray examination normal,after echocardiography confirmed the disease.1 cass underwent pericardial puncture treatment,1 patiens underwent pericardial incision and drainage treatment, the other 1 patient underwent coronary artery bypass surgery and coronary perforation repair.After the treatment,3 patients with no adverse reaction,hemodynamic indexes in normal condition to restore stability ,good condition and prognosis. Conclusion:Cardiac tamponade in cardiac interventional therapy is an extremely rare and more dangerous complications.The timely discovery, quickly identify the cause and appropriate treatment is the guaranteed for patients with a good prognosis.%目的：探讨分析心脏介入性治疗中并发心脏压塞的原因、诊断及治疗方法。方法：分析该院2010年1月-2014年11月间收治的487例心脏介入性治疗患者的临床资料，根据患者的临床表现、超声心动图检查以及X线检查诊断心脏压塞。一旦发现患者出现心脏压塞的症状，立即停止心脏介入性治疗，采取心包穿刺术引流、心包切开引流术、冠状动脉搭桥术和冠状动脉修补术等治疗。结果：本院收治的487例心脏介入性治疗患者中发生心脏压塞并发症患者为3例，发生率为0.62%。发病原因为：房间隔穿刺时误穿左心房壁、左心房壁受损，冠状动脉破裂及心包压塞。2例患者病情经X线片检查得以证实，另外1例患者X线片检查无异样，后经超声心动图检查证实病情。1例患者行心包穿刺术治疗，1例患者行心包切开引流术治疗，另1例患者行冠状动脉搭桥术和破裂冠状动脉修补术，治疗后3例患者均未出现不良反应，血流动力学指标正常，病情恢复稳定，预后状况良好。结论：心脏压塞是心脏介入性治疗中一种极为少见并且较为危险的并发症，及时发现、快速认清病因并进行恰当处理，是患者有良好预后的保证。