心包置管间断抽液治疗心包积液30例观察及护理

目的 探讨心包穿刺置管间断抽液治疗大量心包积液的临床观察及护理.方法 30例心包积液患者应用中心静脉导管,采用Seldinger导管法经皮心包腔内置管间断抽取心包积液.结果 30例患者均穿刺成功,5例出现随呼吸运动心前区轻微疼痛,2例出现引流不畅,改变体位后通畅,1例术后第2天发生心包积液漏入胸腔,无1例发生心包内继发感染.结论 心包腔内置管间断抽液治疗心包积液具有较好的疗效,特别是肿瘤所导致的恶性心包积液,护士应加强置管前后的观察和护理以及预防感染,是提高患者生存质量的关键.     

心包腔内置管间断抽液治疗恶性心包积液18例疗效观察

目的:探讨银屑病与系统性红斑狼疮(systemic lulups erythematosus,SLE)红细胞免疫调节功能的变化.方法:流式细胞仪检测红细胞表面CD58和CD59、血小板CD35及淋巴细胞CD2分子平均荧光强度.结果:银屑病患者红细胞表达CD58、CD59及血小板CD35分子明显高于正常对照组(P＜0.01);CD58与CD2之间呈显著负相关(r=-0.452 P＜0.05),CD58与CD59之间呈显著正相关(r=0.469,P＜0.05),血小板CD35与CD58之间呈显著正相关(r=0.503,P＜0.05);SLE患者的红细胞CD58、CD59及血小板CD35分子明显低于正常对照组(P＜0.01);CD58与CD59之间呈显著正相关(r=0.530,P＜0.05);CD58与CD2之间呈负相关(r=-0.443,P＜0.05);CD59与CD2之间呈负相关(r=-0.357,P＜0.05);血小板CD35与CD2之间呈显著负相关(r=-0.495,P＜0.05).结论:银屑病与SLE患者红细胞天然免疫调控淋巴细胞适应性免疫呈现紊乱.     

心包穿刺置管引流治疗心包积液36例临床分析

目的观察心包穿刺置管引流治疗心包积液的临床疗效和安全性。方法 36例心包积液患者二维B超定位后均采用Seld inger导管法经皮穿刺,心包腔内留置中心静脉导管,进行间断抽吸心包积液、注射治疗药物,观察临床疗效及并发症。同时采用多种措施防止并发症发生。结果 30例采用剑突下置管,6例采用心尖部置管,所有患者均一次穿刺？置管成功,置管进入心包的深度为10～15 cm,留置导管时间7～14 d,穿刺抽液减压后,患者胸闷、呼吸困难等临床症状明显缓解,生活质量提高,1例在置管后抽出100 m l液体时出现头晕出汗,停止抽液后症状缓解;1例出现穿刺孔渗液,随进一步抽吸而消失。均未出现心室扩张和急性肺水肿、气胸、心肌或冠状血管损伤、恶性心律失常等严重并发症。结论心包穿刺置管引流治疗心包积液具有较好的疗效,且方法简便,创伤小,费用低,值得临床继续应用。     

心包腔内置管心包积液引流的疗效观察

目的 :探讨经皮导管心包积液穿刺引流术的方法 ,引流液量的控制 ,引流的体位。方法 :患者取半卧位 ,超声心动图定位穿刺点穿刺深度及方向。 2例患者经剑突下进针 ,10例患者经左侧胸壁进针。采用Sendinger’s法 ,将双腔中心静脉导管送入心包腔内 ,连接无菌引流袋引流积液。结果 :12例患者心包穿刺均获成功。引流管留置时间 1～ 5天 ,平均 2 1± 1 8天 ,引流液量 3 2 0～ 1960ml(平均 812± 2 63ml)。穿刺引流后患者胸闷、气短明显改善 ,休克征象消失。患者心率降低 ,有显著意义 (相应为 93± 2 0次 /min ,82± 14次 /min ,P <0 .0 0 5 )。心功能亦获明显改善。结论 :超声心动图定位 ,心包腔内置管心包积液引流术安全 ,可避免损伤心肌 ,留置导管可使引流彻底 ,疗效可靠     

深静脉留置管在心包积液抽液中的应用

目的 探讨经深静脉留置管行心包穿刺引流可行性、安全性、疗效.方法 对30例心包积液出现心脏压塞或先兆的患者采取经深静脉留置管行心包穿刺引流临床心包压塞.结果 全部成功,一例出现胸膜反应症状.隔天再次穿刺成功;另外两例术中有早博.术后抽液方便、临床症状改善、患者舒适度增加.结论 本方法操作方便、安全、有效,可有效的治疗心脏压塞患者.     

经皮心包内置管抽液治疗心包内积液51例疗效观察

目的经皮心包内置管的安全性及疗效.方法51例大量心包积液患者在超声引导下置管抽液.结果51例置管成功,置管时间平均12 d(5～23 d)均无任何并发症出现.1例出现缩窄心包炎手术治疗.结论经皮心包内置管抽液治疗心包积液安全性高,疗效好.     

中心静脉导管留置并心包腔内药物注射治疗大量心包积液的临床观察

目的：探讨中心静脉导管留置引流并心包腔内药物注射在治疗结核性心包炎及恶性肿瘤伴有大量心包积液的应用价值。方法：将26例大量心包积液患者在B超定位引导下行心包穿刺并留置中心静脉导管引流及心包腔内注射异烟肼和地塞米松（结核性），顺铂（肿瘤性）治疗。结论：心包穿刺留置导管引流心包积液安全可行。操作简便，置管可靠，可迅速消除心包填塞症状，能及时彻底引流心包积液，疗效明显，无不良反应及损伤，降低了缩窄性心包炎的发生率，值得临床推广。     

心包腔内置管可控性持续引流治疗心包积液27例

大量心包积液如不及时治疗可出现心脏压塞，甚至循环衰竭而危及生命。心包穿刺放液是唯一有效的抢救措难，但传统心包穿刺需反复多次操作，且并发症多，我院自2004年2月至2005年2月对超声诊断为中到大量心包积液的27例患者．采取床边经皮心包腔内置入中心静脉导管的方法，可控性持续引流放液，并根据病情需要经导管注入药物至心包腔，疗效显著。     

心包腔内置管引流12例临床分析

心包积液是临床常见征象,多种疾病的并发症,其病因有炎症性、肿瘤性、尿毒症、SLE、黏液水肿及创伤等,其发病率占心血管疾病的1.5%～6%,大量心包积液可致心包填塞,引起严重的临床症状甚至危及生命.心包穿刺术是心内科常用的针对心包积液的治疗技术,但该操作具有一定难度和危险性,尤其是积液量少时,致命性的并发症可高达11.4%～20%[1].以往多采用反复进行心包穿刺抽液,此方法使患者痛苦且危险性大.2003年4月～2005年12月,我科对12例心包积液患者进行心包腔内置入中心静脉导管引流并应用药物,取得较好疗效,安全性高,现报道如下.     

经皮心包内置管抽液治疗心包内积液的疗效观察及护理

目的加强经皮心包内置管患者的疗效观察及护理,提高其安全性.方法49例大量心包积液患者在超声引导下置管抽液.加强术前护理,术中配合,置管后做好体位、心理及生活方面的护理指导,并密切观察病情.结果49例置管成功,置管时间平均11d(5~19d)未发生任何并发症.1例出现缩窄心包炎手术治疗.结论经皮心包内置管抽液治疗心包积液疗效好,安全性高.做好术前、术中、术后观察护理,使患者积极配合,可减少并发症的发生,提高患者的生存质量.     

中心静脉导管留置引流心包积液临床应用

目的：探讨中心静脉导管馏置心包控引流治疗心包积液的实用性、安全性和有技性。方法：采用Selidinger技术将单腔中心静脉导管置入心包腔留置引流心包积液。结果：21例患者均成功引流出心包积液,术后症状快速缓解,导管保留7d-30d,取得良好的治疗效果。结论：心包腔置管引流治疗心包积液疗效满意,并发症少、患者耐受性好、医疗费用少,是安全、方便、实用、有效的治疗方法。     

微创置管在恶性胸腔积液和心包积液治疗中的应用

目的:探讨用中心静脉导管置管引流治疗恶性胸腔积液或心包积液的方法及疗效. 方法:对临床确诊的恶性胸腔积液(n=46)和心包积液(n=13)患者,随机分为微创置管组(n=29)和常规穿刺组(n=30),同时于胸腔或心包腔内注入顺铂(45 mg和10 mg/m2). 结果:对于恶性胸腔积液患者,微创置管组的疗效明显优于常规穿刺组(86.4% vs 54.2%, P<0.05);对于心包积液患者,微创置管组的疗效与常规穿刺组相差不显著(71.4% vs 50.0%, P>0.05). 但所有病例中微创置管组均较常规穿刺组的副作用及并发症低,也能较好改善生活质量(86.2% vs 53.3%, P<0.05). 结论:中心静脉导管置管引流具有创伤小、操作简便安全、疗效较好等优点,且可提高生活质量.     

心包置管引流时间对肺癌心包转移疗效的影响

目的探讨不同心包内置管引流时间对肺癌伴恶性心包积液心包填塞的,临床疗效和安全性。方法将入选的88例患者随机分为A、B两组。A组44例,为长时间置管组,置管时间为〉4周;B组44例,为短期置管组,置管时间〈4周。两组患者均接受相同的心包注射和全身静脉注射药物治疗方案,分别观察6个月内的疗效、生存时间、复发率、生存率及置管并发症发生率。结果A、B两组近期完全缓解率（54．55％VS36．36％,χ2=2．93,P=0．09）和部分缓解率（36．36％vs34．91％,χ2=0．90,P=0．87）差异均无统计学意义,但总有效率比较差异有统计学意义（90．91％vs70．45％,χ2=5．91,P=0．02）,OR=4．19,95％CI：1．24—14．13。半年内的复发率A、B两组分别为20．45％和38．63％（χ2=3．91,P=0．04）。A、B两组中位生存时间分别为7．96、3．52个月,生存率分别为72．47％和51．38％（Logrank=4．76,P=0．04）。两组患者穿刺部位化脓感染发生率分别为4．55％和2．77％（χ2=0．34,P〉0．05）。两组患者均未发现心包化脓感染、窦道形成及严重粘连等并发症。结论适当延长心包置管引流时间,可提高治疗效果,安全性高,可作为肺癌心包积液的首要治疗方法。     

经皮穿刺置管诊断治疗恶性心包积液34例临床分析

目的探讨经皮心包穿刺置管在恶性心包积液诊断和治疗方面的价值.方法治疗组用单腔中心静脉管对34例心包积液患者进行心包穿刺置管引流,并搜集标本进行细胞学和组织学检查,并给予心包内注药化疗.对照组14例合并心包积液的恶性肿瘤患者,只定期行心包穿刺减压和常规细胞学检查,不行心包腔内化疗.结果治疗组有11例患者在术前已找到肿瘤细胞,有17例第1次抽液找到肿瘤细胞,6例在第2次确诊,确诊率为100%;心包内化疗达到完全缓解(CR)者有12例,部分缓解(PR)18例,无效4例,总治疗有效率达88.2%.对照组第1次穿刺抽液确诊4例,第2、3、4次穿刺抽液确诊分别为2例、3例和1例,确诊率为71.43%;单纯抽液达CR者1例,PR者5例,无效8例,有效率达42.86%.结论经皮穿刺置管治疗恶性心包积液是一项非常有效的诊断和治疗方法.     

Causes and prognosis of symptomatic pericardial effusions treated by pericardiocentesis in an Asian academic medical centre

INTRODUCTIONThis study aimed to investigate the causes, clinical management and outcomes of clinically significant pericardial effusions, and evaluate the practice of pericardiocentesis within an academic medical centre in Singapore, a multiethnic country in Southeast Asia.METHODSConsecutive patients undergoing pericardiocentesis at a single Asian academic medical centre were identified. Patient demographics, echocardiographic findings, investigations, pericardiocentesis procedural details and clinical progress were tracked using a comprehensive electronic medical records system.RESULTSOf 149 patients who underwent pericardiocentesis, malignancy (46.3%) was the most common cause of pericardial effusions, followed by iatrogenic postsurgical complications (17.4%). 77.3% of effusions were large and 69.8% demonstrated tamponade physiology. Pericardiocentesis guided by echocardiography and fluoroscopy was successful in 99.3% of patients and had a complication rate of 2.0%. Likelihood of effusion recurrence and survival to discharge was determined by the aetiology of the pericardial effusion. 24.6% of malignant effusions recurred, and the survival rate 12 months after drainage of a malignant pericardial effusion was 45.0%. Short-term mortality was highest among patients presenting with tamponade due to acute aortic syndromes and those with myocardial rupture due to ischaemic heart disease.CONCLUSIONCancer and iatrogenic complications were the most common causes of pericardial effusion in this large cohort of Singapore patients. Pericardiocentesis has a high success rate and relatively low complication rate. Prognosis and clinical course after pericardiocentesis are determined by the underlying cause of the pericardial effusion.     

Management of pericardial effusion by drainage: a survey of 10 years' experience in a city centre general hospital serving a multiracial population

The aim of the study was to determine the aetiology of large and symptomatic pericardial effusions and to review the management and subsequent outcome. A survey was done on a consecutive cases of patients who had undergone percutaneous pericardiocentesis over a 10 year period in a city centre general hospital serving a multiethnic catchment population. In all, 46 patients (24 male, 22 female; age range 16 to 90 years, mean 54 years) underwent a total of 51 pericardial drainage procedures (or attempted pericardiocentesis) between 1989 and 1998. Malignancy (44%), tuberculosis (26%), idiopathic (11%), and post-cardiac surgery (9%) were the most common causes of pericardial effusion. The most common presenting symptoms were breathlessness (90%), chest pain (74%), cough (70%), abdominal pain (61%) (presumed to be related to hepatic congestion), and unexplained fever (28%). In the 12 cases of tuberculous pericarditis, nine occurred in patients of Indo-Asian origin, and three in patients of Afro-Caribbean origin. Fever, night sweats, and weight loss were common among these patients, occurring in over 80% of cases of tuberculous pericarditis. Pulsus paradoxus was the most specific sign (100%) for the presence of echocardiographic features of tamponade, with strongest positive predictive value (100%). Although malignancy remains the most common cause in developed countries, tuberculous disease should be considered in patients from areas where tuberculosis is endemic. Percutaneous pericardiocentesis remains an effective measure for the immediate relief of symptoms in patients with cardiac tamponade, although its diagnostic yield in tuberculous pericarditis is relatively low.     

Seldinger技术指导心包穿刺置管引流治疗急性心肌梗死溶栓并发心包积液

目的评价Seldinger技术指导心包穿刺置管引流治疗急性心肌梗死溶栓并发心包积液的疗效及安全性。方法急性心肌梗死溶栓并发心包积液18例,在床边超声心动图定位指导,采用Seldinger技术,经皮穿刺并内置深静脉留置导管进行心包腔内持续或间断引流心包积液。结果18例患者均1次穿刺并留置导管引流成功．未出现因继发感染、出血、血气胸、严重心律失常、心脏穿破及与心包穿刺置管导致的死亡。留置时间7～21d,平均（9.4±3．7）d;引流量为180～450ml,平均（190±50）ml。结论采用Seldinger技术心包穿刺置管引流治疗急性心肌梗死溶栓并发心包积液,方法简单,安全有效,成功率高,可替代传统穿刺方法。     

Prognosis investigation in patients with chronic heart failure and pericardial effusion

Background  Researchers still do not reach the consensus on the incidence, characters and the prognostic value of pericardial effusion (PE) in patients with chronic heart failure (CHF). This study is to investigate the incidence, characters and the prognostic value of pericardial effusion (PE) in patients with CHF.

Methods  One thousand one hundred and eighty-nine patients, with a diagnosis of CHF consecutively admitted to three centers, were enrolled. M-mode echocardiography was used to determine the presence or absence of PE and to semi-quantify it. The 118 patients with PE and 472 without PE were followed up. The relationship between the PE and other parameters and the prognostic value of PE for CHF were analyzed by univariate and multivariate analyses.

Results  After following up, 550 patients were analyzed, of which 226 were dead. The incidence of PE was 9.92%. Moderate PE was the most common which account 90.68% (107/118). The 6.78% of the patients (8/118) had small while only 2.54% (3/118) had large one. The systolic blood pressure (OR=1.04, 95% CI (1.01–1.07), P=0.08), left ventricular ejection fraction (LVEF) (OR=1.09, 95% CI (1.02–1.15), P=0.06), and main pulmonary artery diameter (MPAD) (OR=1.51, 95% CI (1.24–1.85), P <0.001) were the independent predictors of PE. The glomerular filtration rate (GFR) (OR=1.013, 95% CI (1.005–1.026), P=0.02), systolic blood pressure (OR=1.02, 95% CI (1.00–1.03), P=0.015), LVEF (OR=1.08, 95% CI (1.04–1.12), P <0.001) and diabetes mellitus (OR=3.53, 95% CI (1.99–6.44), P <0.001) were determined as the independent predictors of CHF prognosis.

Conclusions  The PE is not uncommon in CHF patients and most PE are small to moderate. PE is not related to the etiology of CHF while is strongly connected with higher systolic blood pressure, low LVEF and large MPAD. PE dose not increase the risk of death in patients with CHF.

     

心包积液81例病因及误诊分析

目的:分析引起心包积液的病因与误诊原因.方法:对2002～2010年收治的81例心包积液患者的临床资料进行回顾性分析.结果:81例心包积液的主要病因依次是肿瘤性19例(23.4%),结核性16例(16.0%),心力衰竭性11例(13.6%),非特异性9例(11.1%),甲状腺功能减退性7例(8.6%),尿毒症性5例(6...