超声引导下穿刺置管治疗心包积液

目的探讨超声引导下经皮穿刺置管引流在心包积液疾病中的应用价值。方法对2004年5月—2009年5月在我院诊治的28例心包积液患者进行回顾性分析。结果28例心包积液穿刺置管引流术均获得成功。术中超声均能较清晰显示穿刺针穿入心包的位置、导丝进入心包腔的行进方向及深度、导管在心包腔的位置等。并发症主要有疼痛、渗血、引流管阻塞及脱出等。结论在心包积液的诊治中,超声引导下心包穿刺置管引流术具有实时、准确,置管快捷、方便、安全、并发症少等优点,且可在床边进行,是目前心包积液最安全而理想的诊断和治疗方法。     

超声定位引导心包穿刺置管引流治疗心包积液的效果分析

目的观察超声定位引导心包穿刺置管引流治疗心包积液临床效果及安全性。方法对32例心包积液患者实施超声定位引导心包穿刺置管引流术,观察穿刺成功率及术后改善效果及并发症等指标。结果 32例患者均一次穿刺置管成功,穿刺过程未发生头晕、气短、心律失常等不适。术后引流通畅,2例出现穿刺孔渗液伴局部疼痛,考虑心包积液压力升高所致,经进一步抽液后痊愈,未发生引流管阻塞、脱出,继发感染,心肌、冠状动脉组织损伤等。导管留置引流时间为(6.82±2.16)d。患者临床症状均消失或明显缓解。结论采用超声定位引导心包穿刺置管引流术治疗心包积液,创伤小、操作简便,术后并发症少、症状缓解明显、安全性高,患者经济负担轻。     

超声引导经皮穿刺置管引流治疗细菌性肝脓肿的体会

目的总结超声引导经皮穿刺置管引流治疗细菌性肝脓肿的体会。方法对27例细菌性肝脓肿患实施者超声引导经皮穿刺置管引流治疗,观察治疗效果。结果本组27例患者均一次成功完成穿刺及置管引流。未出现脓腔内出血、腹膜炎、败血症等并发症。临床症状消失或明显缓解,体温及血象正常,超声复查示脓腔消失。拔管时间6~14 d,住院时间10~21 d。患者均获随访6个月,未出现复发病例。结论 B超引导下经皮穿刺置管引流治疗细菌性肝脓肿,操作简便、患者痛苦小、治疗效果好,并发症发生率低,恢复快及复发率低,效果肯定。     

心包积液超声引导经皮心包穿刺置管引流术围术期护理体会

目的总结心包积液超声引导经皮心包穿刺置管引流术期间的护理体会。方法对18例心包积液患者在接受超声引导经皮穿刺心包置管引流术期间,实施术前准备,术中医护间配合,加强术后病情监测、体位、导管引流、心理及康复指导等围术期系统护理措施。结果 18例患者一次穿刺置管成功率为100.00%,术后管道引流过程通畅。引流管留置时间5～18 d,平均12.26 d。心包填塞等症状完全消失或显著改善,无感染、计划外管道脱出等并发症出现。结论对心包积液患者实施心包积液超声引导经皮心包穿刺置管引流术的,围术期做好系统护理措施,是提高手术效果,促进患者康复的重要保障。     

超声引导下经皮肝穿刺置管引流治疗肝脓肿并发症分析与防治

目的评价超声引导下经皮肝穿刺置管引流治疗肝脓肿的效果,探讨超声引导下置管引流肝脓肿的安全性及并发症的防治。方法回顾性研究超声引导下经皮穿刺置管引流治疗肝脓肿49例,其中经皮穿刺抽脓18例,套管针法及Seldinger法经皮穿刺置管引流31例,术后2小时、4小时床边超声检查。结果49例肝脓肿患者中1例于术后2小时出血,1例在4小时后出血,1例置管后脓腔破溃而中转手术,引流不畅再次穿刺2例,并发症发生率10.20%（5/49）,除破溃1例外,其余全部治愈,治愈率97.95%（48/49）。结论超声引导下穿刺置管治疗肝脓肿安全可靠、并发症低、治愈率高。床边超声的应用有助于及时发现并发症,尽早采取有效治疗手段。     

超声引导锥形套管针穿刺在心脏压塞救治中的应用

目的探讨超声引导下锥形套管针穿刺在心脏压塞救治过程中的应用价值。方法 1998年3月~2015年10月,在超声引导下使用锥形套管针(专利号:ZL 2006 2 0132265.8)对28例大量心包积液(心包积液宽度≥17 mm)引起的心脏压塞进行心包穿刺,置入引流管引流。选择Seldinger法心包置管治疗心脏压塞患者28例作为对照组,比较2组的置管时间。结果所有心脏压塞患者均一次穿刺成功并置入引流管,锥形套管针组置管时间(6.2±1.1)min,比Seldinger组(15.0±1.1)min明显缩短(t=-27.844,P=0.000),引流后患者心脏压塞症状均消失。结论在大量积液引起的心脏压塞患者的救治过程中,超声引导下锥形套管针穿刺置管操作简便,创伤小,快速安全,疗效确切,也为后续治疗提供了保障。     

超声引导下经皮心包穿刺置管引流术的围术期护理

目的探讨超声引导下经皮心包穿刺置管引流术的围术期护理方法。方法对25例心包积液患者实施超声引导下经皮穿刺心包置管引流术期间,认真完善术前准备及心理疏导,熟练术中配合,加强术后病情观察及引流管护理等干预。结果 25例均一次穿刺置管成功,术后引流通畅。导管留置时间4~12 d,其间1例发生导管堵塞,经肝素生理盐水冲洗后再通。未发生感染、组织脏器损伤等严重并发症。心包填塞等症状明显改善。结论心包积液患者实施超声引导下经皮穿刺心包置管引流术期间,给予科学、规范的护理,可提高穿刺成功率,减少并发症,为有效改善患者症状奠定良好基础。     

超声引导经皮穿刺置管引流术治疗细菌性肝脓肿的临床体会

目的观察超声引导经皮穿刺置管引流术治疗细菌性肝脓肿的临床效果。方法对32例细菌性肝脓肿实施引导经皮穿刺置管引流术。结果 32例患者均一次穿刺置管引流成功,经置管引流后症状消失,体温、白细胞计数均恢复正常。置管时间(9.6±1.3)d,住院时间(10.6±3.8)d。未发生腹膜炎、邻近组织损伤、大出血等并发症。经超声检查证实脓腔闭合后出院。随访6个月,复查超声无复发病例。结论超声引导经皮穿刺置管引流术治疗细菌性肝脓肿,创伤小、患者术后恢复快,复发率低,效果满意。     

超声引导下经皮穿刺引流术治疗胰腺炎局部并发症70例

目的:探讨超声引导下经皮穿刺置管引流术治疗胰腺炎局部并发症的临床应用价值。方法:采用超声引导经皮穿刺引流术治疗70例胰腺炎局部并发症患者,术后随访1~20个月,观察患者腹部症状,引流液的量及性状,CT复查胰腺及周围情况等。结果:70例共穿刺置管82支,由于液体腔分隔同时置入2支导管12例;腹部疼痛减轻或消失,腹胀改善,全身炎症反应减轻;2例拔管后复发,再次穿刺引流。结论:超声引导下经皮穿刺引流术治疗胰腺炎局部并发症,安全、成功率高、治疗效果佳。     

经直肠超声引导下穿刺置管引流治疗高位肛周脓肿的临床研究

目的:探讨应用经直肠超声引导下穿刺置管引流治疗高位肛周脓肿(HPA)的临床效果。方法:将2019年3月至2022年3月我院收治的80例HPA患者按照随机数字表法分为观察组和对照组，各40例。对照组行传统切开引流治疗，观察组行经直肠超声引导下穿刺置管引流治疗。比较2组治疗总有效率，术后疼痛、渗出情况及脓腔最大截面积、创面愈合时间等。结果:2组治疗总有效率比较差异无统计学意义，P>0.05。观察组术后第3天和第7天疼痛程度及渗出情况评分均低于对照组，脓腔最大截面积小于对照组，P<0.05。观察组创面愈合时间明显短于对照组，尤其是直肠后间隙脓肿和高位括约肌间脓肿，P<0.05。结论:经直肠引导下穿刺置管引流治疗HPA疗效确切，与传统切开引流相比，患者术后疼痛更轻、渗出更少，创面愈合更快。     

Intrapericardial fibrinolytic therapy in purulent pericarditis.

OBJECTIVE: Purulent pericarditis is a rare disease that is being conventionally managed with intravenous antibiotics and pericardial drainage. In our study, we used intrapericardial fibrinolytic treatment together with pericardiocentesis and antibiotic therapy. We evaluated the role of intrapericardial fibrinolytic treatment in nine purulent pericarditis patients. METHODS: Six children and three adult patients with purulent pericarditis, aged between 5 and 50 years, were treated with intrapericardial fibrinolysis by streptokinase. Intrapericardial drainage catheter was placed into the subxyphoidal localization under local anaesthesia and echocardiography guidance, streptokinase was infused into the pericardial sac as the fibrinolytic agent. RESULTS: Repeat echocardiograms showed no reaccumulation of pericardial effusions, pericardial thickening or constrictions. No patients had systemic bleeding, arrhythmias, or hypotension. There was one death which was due to sepsis and congestive heart failure. CONCLUSION: We believe that early pericardial drainage and intrapericardial fibrinolysis appears to be safe and effective in the treatment of purulent pericarditis.     

Laparoscopic transabdominal pericardial window

Creation of a transabdominal transdiaphragmatic pericardial window for life-threatening recurrent pericardial effusion has proved to be a safe minimally invasive technique. By inducing adequate pericardial sac decompression while avoiding single-lung ventilation and thoracic drainage in severely ill patients, it provides anatomopathologic diagnosis and can direct further therapeutic measures. The transabdominal approach improves postoperative recovery dramatically by limiting postoperative pain and prevents sometimes invalidating intercostal neuralgia. Transabdominal pericardial sac fenestration should be part of the armamentarium used by every minimally invasive surgeon.     

Cardiac tamponade associated with a peripheral vein central venous catheter

We present a case of cardiac tamponade associated with placement of a central venous catheter (CVC) via a peripheral vein in a 14-year-old girl with idiopathic scoliosis undergoing corrective surgery. A number of complications have been described in association with CVC misplacement. Sporadic cases of cardiac tamponade from this have been reported, but the actual incidence is unknown. Death from cardiac tamponade attributed to CVCs ranges from 65 to 100%. In our patient, cannulation of the pericardiophrenic vein was probably the cause of cardiac tamponade, based on radiological evidence that the initial location of the catheter was near the right atrium and possibly at the outlet of the pericardiophrenic vein. The catheter could have advanced into the vein and then to the pericardial sac with postural changes. The acute clinical course of cardiac tamponade in our patient had potentially lethal hemodynamic repercussions. The main diagnostic test for this condition is echocardiography and the only effective treatment is drainage of the pericardial effusion. Echocardiography should be performed before pericardiocentesis except in life-threatening situations or high clinical suspicion. Although they are rare, it is important to be aware of the potential for CVC complications.     

Successful repair of a diaphragmatic hernia through a pericardial window with acellular dermal matrix

A successful placement of a transabdominal pericardial window is associated with diaphragmatic hernia. In this paper, we present the case of a 5-month-old ex-31-weeks-premature baby who developed a symptomatic diaphragmatic hernia following a chronic pericardial effusion who was treated successfully with a laparoscopic transabdominal pericardial window. Laparoscopy and a pericardial window were used to manage the symptomatic effusion that developed following a bilateral thoracotomy and median sternotomy for the patient's massive hygroma. The patient was followed before and after pericardial drainage with a serial examination, chest radiography, and echocardiography. In addition, computerized tomography was also used for long-term follow-up following the repair of the hernia. An acellular dermal matrix was utilized for patching the hernia with a laparotomy. The abdominal approach in both operations offered direct access to the pericardial space and hernia, thereby avoiding previously operated thoraces. A subsequent follow-up at 9 months following the creation of the window suggested a recurrent tamponade physiology. Plain radiographs and an echocardiogram showed herniation into the pericardial sac. The hernia was operatively reduced and repaired with an acellular dermal matrix. Recovery and subsequent followup at 1 year revealed no hernia, full symptom resolution, and no recurrence of the pericardial effusion. A pericardial window is an effective approach for the management of chronic pericardial effusion. Diaphragmatic herniation through a pericardial window can be successfully repaired with an acellular dermal matrix.     

Surgical treatment for right ventricular perforation caused by transvenous pacing electrodes: A report of three cases

We experienced three cases of right ventricular perforation that were induced by transvenous pacing electrodes. The patients were a 72-year-old man who underwent percutaneous transluminal coronary recanalization and angioplasty, an 80-year-old woman who had temporary transvenous pacing for a complete atrioventricular block induced by acute valvular heart failure, and a 44-year-old man who had received a permanent pacemaker. All three patients were treated surgically. The first and second patients demonstrated either cardiac tamponade or hemopericardium necessitating pericardial drainage. Spontaneous hemostasis did not occur in cases 1 and 2, due to either anticoagulant therapy or myocardial degeneration. Such patients require surgical closure of the perforation and pericardial drainage as soon as pericardial effusion is confirmed. In contrast, middle-aged individuals without myocardial damage, such as patient 3, need only a simple removal and repositioning of the electrode followed by serial echocardiography.     

Porridge-like tuberculous cardiac tamponade: treatment difficulties in the Horn of Africa

A 16-year-old boy was hospitalized for fever, chest pain, and cardiovascular collapse. Transthoracic echocardiography revealed a 30-mm circumferential echogenic “porridge-like” pericardial effusion with signs of cardiac tamponade. Tuberculosis (TB) was suspected because of its prevalence in Djibouti. Emergency pericardiocentesis was attempted, but only 10 ml of pericardial fluid was obtained. Subxiphoid pericardiotomy and drainage were then performed, and pericardial fibrinous pockets were surgically collapsed. Antituberculosis chemotherapy was given, and the pericardial effusion progressively disappeared without corticosteroids. The diagnosis of TB was subsequently confirmed by cultures of the pericardial fluid. A pericardial biopsy was normal. After 3 months of follow-up, there was no sign of constrictive pericarditis. Pericardiocentesis may fail in cases of advanced-stage fibrinous TB pericardial effusion. Thus, pericardiotomy with complete open draining is the only lifesaving procedure.     

MRI as guide to surgical approach in tuberculous pericardial abscess. Case report.

In a 30-year-old man with tuberculous pericardial effusion and symptoms of constrictive pericarditis, 2-D echocardiography indicated localized effusion. Subsequent magnetic resonance imaging showed the effusion to be posterior and compressing the left ventricle. Guided by this information, pericardial resection with drainage of tuberculous abscess was performed via left anterior thoracotomy.     

Acute cardiac tamponade due to a bleeding pericardial cyst in a 3-year-old child

We report a case of a pericardial cyst complicated with acute cardiac tamponade in a 3-year-old child with no previous cardiac history who was transferred to our university hospital because of hemodynamic shock. A chest roentgenogram revealed marked cardiac enlargement, and transthoracic echocardiography showed massive pericardial effusion with a moving cystic structure. Percutaneous needle aspiration yielded bloody pericardial fluid. Emergency drainage of the pericardial effusion and resection of the cyst were performed through a median sternotomy. We found a blood-containing cyst that was attached to the right atrium near the sinus node and to the inferior wall of the pericardial cavity.     

Placement of pericardial drainage tube for the treatment of pneumopericardium in the neonate

A method for resolving the life-threatening complication of neonatal pneumopericardium is described. In patients suspected of having this complication, needle aspiration of the pericardial sac should be performed to confirm the diagnosis. Then a tube should be inserted directly into the sac, attached to continuous-suction drainage, and allowed to remain in place until positive end-expiratory pressure is discontinued. The technique has not been associated with morbidity, mortality, or recurrence of pneumopericardium.     

Effect of timing of chest tube removal on development of pericardial effusion following cardiac surgery

BACKGROUND: There are no standard criteria for the timing of drain removal. The objective of this study was to determine whether the macroscopic appearance of chest tube drainage fluid to serosanguineous may be used as a criteria for drain removal. METHODS: 2,359 patients were assessed retrospectively and 80 randomized patients were followed prospectively who underwent cardiac surgery. In both parts of the study, patients were divided into two groups according to the timing of drain removal. Group I consisted of patients whose chest tubes were removed as soon as the macroscopic appearance of the drainage fluid turned to serosanguineous. Group II consisted of patients whose chest tubes were removed at the second postoperative day when the drainage output declined to less than 50 mL in a five-hour period. In the retrospective part, cases of hemodynamically significant pericardial effusion observed within seven days postoperatively were reviewed. In the prospective part, just before the drain removal, the fluid sample hematocrit obtained from the drain lines and patients' blood hematocrit were measured and recorded. Patients were evaluated with echocardiography for pericardial effusion. RESULTS: No statistically significant difference was detected in the frequency of hemodynamically significant pericardial effusion and incidence or amount of pericardial effusion between the two study groups. The drain hematocrit to blood hematocrit ratios before drain removal showed a significant correlation with pericardial effusion.The strength of correlation between the drain hematocrit to blood hematocrit ratios before drain removal and pericardial effusion was also studied using receiver operating characteristic curve, which suggests that a drain hematocrit to blood hematocrit ratio of < or = 0.3 is strongly predictive that pericardial effusion would be absent or mild between the fifth and seventh postoperative days. CONCLUSIONS: It is safe to remove the chest tubes as soon as the macroscopic appearance of the drainage fluid turns to serosanguineous since this practically indicates cessation of active bleeding.