心脏介入治疗患者并发心脏压塞的早期识别与抢救护理

目的探讨心脏介入治疗患者早期发生心脏压塞的识别及抢救体会。方法选取本院收治的10例行心脏介入治疗发生心脏压塞患者的临床资料,分析其发生心脏压塞的早期症状、急救措施及护理原则。结果在本组10例患者中有8例患者术中发生心脏压塞,另2例患者为迟发型术后5h内发生心脏压塞,经心包引流,病情得以控制,9例患者救治成功,1例患者死亡。结论严格掌握心脏介入的适应证,对于高危患者术中操作要轻柔,避免损伤冠状动脉,密切观察病情并早期识别,争取宝贵的抢救时间是救治成功的关键。     

Gross pericardial effusion with tamponade in 2<Superscript>nd</Superscript> trimester of pregnancy

Hypothyroidism in pregnancy is associated with serious maternal and fetal risk. Rarely, it is manifested by life-threatening cardiac complications, such as gross pericardial effusion and tamponade. We present a case of successfully treated gross pericardial effusion and tamponade in a 22-week pregnant woman with hypothyroidism. The patient was treated by pericardial drainage with further treatment of hypothyroidism with levothyroxine. During the follow-up pregnancy was uncomplicated without recurrence of pericardial effusion and successful delivery of full-term baby. We conclude that careful monitoring of thyroid functional tests and proper management should be performed in pregnant women with hypothyroidism to prevent cardiac complications of the disease, like pericardial effusion and tamponade.     

心包穿刺置管治疗心包积液20例分析

目的探讨经皮心包穿刺置管持续引流心包积液的疗效及安全性。方法 20例中到大量心包积液的患者在超声引导下穿刺置管引流。结果 20例患者均穿刺置管成功,导管留置时间2～7d,均无组织脏器损伤及感染,心包积液引流彻底,心包压塞症状消失。结论经皮心包穿刺置管持续引流是一种安全有效,完全能替代以往常规心包穿刺术。     

Management of uraemic pericarditis.

Of 250 patients undergoing haemodialysis from 1967 to 1974 17 presented with uraemic pericarditis. Seven of these patients who had been transferred early enough to peritoneal dialysis treatment were cured without pericardiectomy (mean survival 18 months (range 6-36); no deaths). Only one patient was cured from his pericarditis by "aggressive haemodialysis." In seven out of 10 patients treated with haemodialysis, pericardiectomy finally had to be performed because of pericardial tamponade (postoperative survival 20 months (range 8-36); one death). Two patients died from pericardial tamponade before surgery. In patients with evidence of uraemic pericarditis frequent peritoneal dialysis with high fluid withdrawal is the treatment of choice, but in cardiac tamponade pericardiectomy should follow a preoperative pericardiocentesis with limited fluid aspiration. Of possible significance in the aetiology of pericarditis were the findings that 10 of the 17 patients had hypertension with cardiac enlargement and that 14 presented with evidence of underdialysis, possibly due to the reuse of dialysis components.     

PCI术后急性心包填塞早期识别抢救与护理

目的 探讨PCI术后急性心包填塞早期识别抢救与护理对策.方法 回顾性分析7例心脏介入术后并发急性心包填塞的临床资料,严密观察病情,及早识别,穿刺过程中严密监测生命体征、心包引流管的护理,停用抗凝药物,做好心理护理.结果 本组5例患者均经心包穿刺引流并留置引流管抢救成功;1例因病情重,家属主动放弃抢救治疗.1例因合并大片脑梗死,经抢救无效死亡.结论 立即行心包穿刺术排除心包积血,解除心脏受压是介入术后发生急性心包填塞抢救成功的关键.加强病情观察及引流管的护理,是预防术后其他并发症的重要措施.     

Diagnosis and treatment of acute cardiac tamponade by the subxiphoid approach

Emergency cardiac surgery has been performed on 18 cases of acute cardiac tamponade whose etiologies were as follows: 11 cases of metastatic carcinoma, four cases of idiopathic pericarditis and three with other causes. In most cases, the chief complaint was dyspnea. In many cases, the cardiac silhouette of frontal chest X-ray films showed the shape of a water-filled ice-bag placed on a table. The electrocardiogram showed a low voltage and a flat T-wave in approximately half of the patients. In cases of an echo-free space 1 cm or larger on the M-mode echocardiogram, the average amount of pericardial fluid drained was 850 ml and in those in which the space was less than 1 cm, the average drained was 557 ml. The CT values were 9-40 for patients with malignant pericardial effusion and 20-22 for cases of idiopathic pericarditis. In general, pericardiocentesis was performed in almost all the patients with acute tamponade, but if the drainage was inadequate, the subxiphoid pericardial window procedure was performed under local anesthesia. Surgical invasion in this technique was minimal and the operative results proved effective. For the operation, we resected a 2 X 2 cm pericardial segment. Since two of the patients with malignant pericardial effusion developed postoperative reaccumulation, resection of a 4 X 4 cm segment in the future has been contemplated.     

ECHO and magnetic resonance imaging in a patient with high bleeding risk and ventricular perforation: a case report and literature review

Myocardial perforation is a complication following pacemaker implantation that may cause cardiac tamponade. We present an original case of myocardial lead perforation not complicated by acute cardiac tamponade. The patient with an acute myocardial infarct had a high bleeding risk both in the acute phase of lead insertion (anticoagulant and triple platelet anti-aggregation therapy) and after few days, the percutaneous extraction lead for the double platelet antiaggregant therapy. Torrent-Guasp's theory is considered for explaining the clinical course of patient. Echocardiography and magnetic resonance imaging (MRI) evaluation showed a diffuse pericardial non-hemorrhagic fibrinous effusion and guide the clinical management.     

阿糖胞苷致急性白血病患者心包积液、急性心包填塞死亡

1例36岁男性患者因急性白血病给予DA方案（柔红霉素100mg,1次/d静脉滴注,第1～3天;阿糖胞苷早100mg、晚150mg静脉滴注,第1～7天）化疗。入院第6天胸部CT检查示心包增厚;入院第11天患者出现咳嗽、气短、心悸。BP145/105mmHg,HR120次/min,心音遥远。结合超声心动图,考虑为心包积液、急性心包填塞。急行心包穿刺术,穿刺失败,患者于入院第12天因呼吸循环衰竭死亡。     

Critical cardiac tamponade in newborn, life-saving emergency interventions and possibility of parvovirus B19 congenital infection

The presence of pericardial effusion in neonates usually indicates a poor prognosis. Here, we report a case of isolation of cardiac tamponade in a newly born. This may be related to vertical human parvovirus B19, an infection with atypical clinical manifestation. Any neonate with unexplained fetal pericardial effusion should always be tested for parvovirus B19 infection, even in the absence of known and proved fetal exposure. Despite the etiology of a tamponade the only reasonable procedure is a surgical evacuation during diagnosis.     

A study of serum levels of cefoperazone sodium and its movement to myocardial tissue

After introduction of anesthesia to 19 patients requiring cardiac surgery, cefoperazone sodium (CPZ) 1 g was administered intravenously and its movement to serum, pericardial fluid and tissue of the right auricle was studied. The serum CPZ level was 75.68 micrograms/ml and 59.77 micrograms/ml at 60 and 120 minutes after administration, respectively, and the biological half-life time was 2.54 hours. Lengths of time to achieve peak concentrations of CPZ in pericardial fluid and right auricle tissue after administration were both approximately 1 hour. The drug level in myocardial tissue was 14.52 micrograms/g after 240 minutes. Level of CPZ in myocardial tissue was maintained, even after 240 minutes, sufficiently higher than MIC80 of the drug against Gram-negative bacilli which may be responsible for many infections. No side effects were observed in any case examined.     

亚胺培南西司他丁钠与盐酸万古霉素联用致嗜酸粒细胞增多伴皮疹

1例80岁女性患者因股骨髁间骨折切开复位内固定术后切口引流液培养检出阴沟肠杆菌,给予亚胺培南西司他丁钠0．5g,17欠／8h静脉滴注。第3天,嗜酸粒细胞计数由用药前的230×10^6／L升至520×10^6／L。第9天,嗜酸粒细胞计数为770×10^6／L。第11天,因切口引流液培养检出凝固酶阴性葡萄球菌,加用盐酸万古霉素1g,1次／12h静脉滴注。第18天,嗜酸粒细胞计数升至1810×10^6／L,停用亚胺培南西司他丁钠。第21天,患者出现双下肢皮疹伴瘙痒,给予抗过敏治疗。第26天,患者病情好转,嗜酸粒细胞计数仍高达2990×10^6／L,停用盐酸万古霉素。其后皮疹逐渐消退。第48天,嗜酸粒细胞计数降至20×10^6／L。     

介入术后急性心脏压塞的护理策略

目的 探讨经桡动脉行冠状动脉造影介入治疗患者并发心脏压塞的早期征象,诊治流程及护理策略,从而改善预后、降低病死率.方法 回顾性分析2011年1月至2013年10月年北京安贞医院抢救中心采用经桡动脉行冠状动脉造影介入治疗5 595例患者临床资料.结果 心脏压塞的早期征象为胸痛、极度烦躁、面色苍白、大汗,呼吸困难、血压下降,特别是收缩压下降、心率增快,早期诊断手段为超声心动图;护理工作应认真观察患者生命体征,及时上报,做好心包穿刺护理工作,避免心包穿刺并发症发生.本研究结果显示在5 595例介入检查患者中8例发生心脏压塞,发病率为0.14%,经及时发现积极抢救,救治成功率为100%.结论 早期发现经桡动脉行冠状动脉造影介入治疗后心脏压塞,正确诊断,积极护理,可以改善预后、降低病死率.     

心脏介入术并发症的探讨分析

目的探讨心脏介入术并发症并进行分析。方法 2007年2月至2012年2月我院开展的心脏介入手术2032例了解心脏介入术中并发症发生率,并发症种类及构成比。结果 2032例心脏介入手术发生并发症65例,并发症发生率3.20%,并发症包括出血血肿、拔管综合征、血管内膜损伤、血栓形成或栓塞、严重心律失常、心包填塞等。结论心脏介入术并发症与术中操作有直接关系,但术前进行全面的检查发现隐患,积极控制避免发生并发症,并制定详细的救治预案,准备好各种抢救物品,尽量避免并发症发生,对发生并发症能够正确、及时处理,避免发生恶性事件。     

无骨折开放性软组织创伤的早期治疗体会

目的：探讨无骨折开放性软组织创伤的早期治疗措施。方法：对我院1997-2003年收治的无骨折开放性软组织创伤病人进行了回顾性分析。结果：本组病人经有效的早期治疗，Ⅰ期治愈率达85.2％。结论：无骨折开放性软组织创伤的早期治疗首先是院前的简单有效止血，院内的进一步止血、抗休克治疗，再是清创缝合、重建功能。     

Tenecteplase for malignant pericardial effusion

Pericardial effusions may necessitate placement of a catheter into the pericardial space for continuous drainage. If the effusion material is fibrinous or loculated, drainage may slow or cease over time, allowing reaccumulation. Limited data exist to guide the selection of a fibrinolytic agent and the most appropriate dose. We report the case of a 79-year-old woman with malignant pericardial effusion who responded to intrapericardial administration of tenecteplase to facilitate drainage. The patient received three doses of tenecteplase--15 mg, 7.5 mg, and 7.5 mg--over 3 days, resulting in significant drainage. No adverse effects were noted except for a transient episode of hemodynamically stable atrial fibrillation. Use of fibrinolytic agents to facilitate pericardial drainage may offset the need to repeatedly replace the catheter if flow subsides despite continued presence of fluid in the pericardial space.     

成人心脏术后心包胸骨后固定后的出血患者70例临床分析

目的研究心脏手术关胸时渗血严重病例,用心包胸骨后固定方法,观察术后出血情况,了解此方法是否能够减少术后出血。方法选择同期心脏手术后渗血严重心包完整病例,对比心包胸骨后固定后出血量、术后感染、胸腔积液、心包填塞、呼吸机使用时间及血流动力学改变是否有明显差别。结果心包胸骨后固定在心脏手术后渗血严重心包完整病例中,能有效减少术后出血量,减少用血量,减少医疗费用,证明心包胸骨后固定不失为减少术后出血的一个办法。结论对比心脏手术心包完整创面渗血严重病例,关胸时,将心包胸骨后固定,以此将前纵隔和心包腔分隔开,心包紧贴于胸骨后,以此达到压迫止血目的。对比类似常规关胸病例,出血明显减少,证明心包胸骨后固定能够有效减少术后出血,减少术后用血量,降低医疗费用。     

医源性胆胰肠结合部损伤的外科治疗

目的探讨医源性胆胰结合部损伤的诊断和外科治疗。方法对我院1998—2010年期间收治的13例医源性胆胰结合部损伤患者的临床资料进行回顾性分析。结果5例术中发现者,施行裂口修补＋胆总管T管引流＋腹膜后引流术,术后2例并发切口感染,1例并发十二指肠瘘,均经保守治疗治愈。8例术后发现者,2例患者继发后腹膜脓肿及髂窝脓肿先行脓肿穿刺引流术,后因引流不畅行切开引流;1例合并胰腺、十二指肠损伤者术后出现十二指肠瘘、腹膜后脓肿并大出血再次急诊行清创止血引流＋胃空肠吻合加胃窦部可吸收线捆扎术,术后经积极治疗痊愈;2例并发切口感染。所有患者恢复顺利出院。结论早期诊断胆胰肠结合部损伤并及时手术治疗可取得较好效果．府根据榻伤的不同稗席采用不同的手术方式．     

心包固定液的制备工艺改进及稳定性考察

目的改进心包固定液的制备工艺并考察其稳定性。方法将心包固定液的制备分为A液（缓冲液）、B液（戊二醛液）,配制完成后置于冰箱冷藏备用,临用前A、B两液等量混合均匀,得到新鲜配制的心包固定液。采用酸度计和羟胺盐法,以pH值和含量为指标,对消毒前、后的A液与B液,以及B液、心包固定液在常温放置、冷藏储存多种情况下进行稳定性考察。结果消毒后A液、B液的pH值及含量均有所降低,但降幅很小,且在规定范围内。临用前将A液、B液混匀,戊二醛处于碱性条件下,具有强杀菌活性和心包固定作用;稳定性考察表明,B液、心包固定液、AB混合液常温放置半年pH值和含量已不符合规定,冷藏放置1年各项指标正常,稳定性较好。结论心包固定液制备工艺的改进合理、可行,样品稳定性好,保质期延长至1年。     

30例腹部贯通伤患者的抢救及护理配合分析

目的探讨腹部贯通伤患者的抢救方法及其护理配合效果。方法随机选择2007年1月至2013年1月我院收治的30例腹部贯通伤患者作为研究对象,对患者的临床资料进行回顾性分析,探讨有效治疗腹部贯通伤患者的抢救和护理方法。结果 30例患者中,29例患者在进行抢救和护理治疗后,病情全部好转并最终痊愈出院,有效率为96.7%。1例因为同时并有严重的心包填塞,抢救无效死亡。结论及时对腹部贯通伤患者进行抢救治疗,并配合熟练的护理,能够在很大程度上提高腹部贯通伤患者的治愈率。     

心包穿刺置管注射香菇多糖治疗恶性心包积液的疗效观察13例

目的探讨和评价微创经皮心包腔内置管引流并注入香菇多糖治疗恶性心包积液的效果。方法 B超引导下,以心左浊音界及剑突下为穿刺点,将中心静脉导管置入心包腔,放液干净后注入香菇多糖。结果心包腔内置管并注入香菇多糖与单纯置管引流控制心包积液有效率分别为61.5%及28.5%,差异具有显著性。结论心包腔内置管并注入香菇多糖,疗效佳,不良反应轻,可控制心包填塞症状。