心脏介入术并发急性心包填塞的临床分析

【】 目的 总结心脏介入术中并发急性心包填塞的防治体会。方法 回顾性分析6例心脏介入术中发生急性心包填塞患者的发病特点、发生原因及处理措施。结果 二尖瓣球囊扩张术(PBMV)中1例为房间隔穿刺位置过高致右心房穿孔而发生急性心包填塞,经紧急心外科手术救治成功,1例为送入穿刺鞘致心房穿孔所致,超声引导下心包穿刺置管引流48h后痊愈；冠状动脉介入治疗术(PCI)中1例为反复推送导丝穿破高度狭窄钙化的左前降支所致, 经紧急心外科手术救治成功,1例为急性前壁心肌梗死PCI时发生,经对症治疗及置管引流48小时后痊愈；射频消融术(RFCA)中1例为放置左上肺静脉电极导管时不慎将左心耳穿破所致,行猪尾导管引流、输血、升压等措施后心包填塞症状缓解；心脏永久性起搏器植入术中1例为电极损伤冠状静脉所致,行超声下猪尾导管心包穿刺引流及输血等治疗后,病情稳定。结论：急性心包填塞是心脏介入术的严重并发症,积极预防、及时发现、果断处理是防治的关键措施。

Clinical Analysis of Cardiac Interventional Surgery Complicating Acute Cardiac Tamponade

Objective: To summarize the experience of preventing the cardiac interventional surgery complicating acute cardiac tamponade. Method: To analyze the features, causes and measurements of 6 patients who had complicated acute cardiac tamponade in interventional surgeries. Result: In one case of PBMV, the atrial septal puncture position was so high that caused right atrial perforation and then acute cardiac tamponade. It had received a successful treatment after emergency surgery; one case was caused by senting puncture sheat, and recovered in 48h after ultrasound-guided percutaneous catheter drainage of pericardium; one case of PCI was caused by repeatedly push of guide wire and pierced highly calcified stenosis of the left anterior descending artery. It had received a successful treatment after emergency surgery; one case happened in PCI as acute myocardial infarction, and recovered in 48h by treatment and catheter drainage; one case in RFCA was caused by the accidentally puncture of left auricle when placing left pulmonary vein catheter electrode, and was relieved after several measurements as pigtail catheter drainage, blood transfusion and boosting; one case in permanent cardiac pacemaker implantation was caused by electrode damage of coronary vein, and the disease was stable after the treatments as ultrasound pigtail catheter pericardiocentesis and blood transfusion. Conclusion: Acute cardiac tamponade is a serious complicating disease of cardiac interventional surgery, and the key measurements are preventing actively, discovering in time and taking decisive treatment.