超声引导下经皮穿刺引流治疗心包积液

目的探讨超声引导经皮穿刺引流治疗心包积液的安全性、成功率及临床应用。方法对36例心包积液的患者在超声引导下进行经皮穿刺,在心前区或剑突下置入中心静脉导管,观察心包积液引流情况及并发症。结果 36例心包积液患者全部安全、有效、成功置管引流,术后心包积液引流通畅,心脏压塞症状缓解,未出现气胸、心室扩张急性肺水肿、心肌或冠状血管损伤、感染等并发症。结论超声引导经皮穿刺引流是治疗心包积液简单、安全、有效的方法,便于临床应用。     

B超引导下心包穿刺置管在心包积液诊治中的临床应用

目的讨论B超引导下经皮心包穿刺置管持续引流心包积液的疗效、安全性及临床应用。方法在心尖部或心前区置入中心静脉导管引流。结果80例心包积液病人全部安全有效、置管成功，得到有效救治。8例心包填塞患者引流后症状迅速缓解。可长期保留（5～16天）。操作并发症少。结论B超引导下经皮心包积液置管法简单、安全、有效，便于临床应用。     

超声引导下心包积液穿刺及置管引流的临床研究

目的探讨超声引导下心包积液穿刺及置管引流的临床应用价值。方法176例心包积液患者，行超声检查确定心包积液程度，并设定穿刺路线。局麻下采用18G PTC穿刺针或16GEV穿刺针在超声引导下进入心包腔抽吸液体，必要时置管引流。结果176例心包积液均穿刺成功，并发症1例（0．57％），为快速房颤。结论超声引导下心包积液穿刺及置管引流安全、准确、有效，有较高临床应用价值。     

超声引导下用EV针穿刺置管引流在心包积液中的应用

目的：探讨用EV针在超声引导下经皮心包穿刺置管引流心包积液的临床应用价值。方法：29例患者均系术前行超声心动图检查筛选的中、大量心包积液患者,在心尖部设定穿刺进针线路,局麻下用18GEV穿刺针在超声引导下沿穿刺引导线进入心包腔,采用EV针塑料外套管留置引流。结果：29例心包积液患者中,28例均一次穿刺成功,1例因心包增厚使EV针塑料外套管尖端破裂而改用18G PTC针穿刺成功。结论：用EV针在超声引导下心包积液穿刺置管引流简单、安全、准确、有效,便于临床应用。     

心包穿刺置管治疗心包积液23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：23例中等量到大量心包积液的患者在超声引导下穿刺置管行心包持续引流。结果：23例患者均置管成功，留置时间平均5（3～13）d，均无组织脏器损伤及感染。结论：经皮心包穿刺置管持续引流是一种安全、有效的治疗心包积液方法。     

超声引导剑突下心包置管引流治疗恶性心包积液

超声引导剑突下心包置管引流治疗恶性心包积液谢贤桂彭俊平宋煜宏伍海翔庄翔超声引导经皮剑突下心包穿刺置管治疗大量恶性心包积液２１例，结果安全有效。现报道如下。本组２１例，男性１４例，女性７例。平均年龄５２（４７～６１）岁，１２例以心包填塞症状入院，另９例...     

心包积液76例置管引流的体会

目的为了探讨经皮穿刺置入导管引流心包积液的疗效与安全性。方法76例心包积液的患者在超声引导下置管行心包闭式引流。结果76例患者均置管成功。置管时间3～34d，平均12d，均无脏器、组织损伤或感染等。结论经皮穿刺置入导管行心包引流是一种安全，有效的治疗方法。     

经皮穿刺心包置管引流治疗心包积液—附38例报告

目的探讨经皮穿刺置入导管引流心包积液的疗效及安全性。方法38例中等量至大量心包积液患者，在超声引导下置管行心包闭式引流，观察其效果和安全性。结果38例患者均置管成功，置管时间6～30d（平均10d），均无脏器、组织损伤或感染等情况出现。3例发生导管堵塞，经肝素盐水冲洗后再度通畅；1例出现症状性低血压，以予补液体、升血压药治疗后血压恢复。结论经皮穿刺置入导管行心包引流是一种安全、有效治疗心包积液的方法。     

彩超在100例心包穿刺置管中的应用分析

目的探讨超声引导下心包腔内置管治疗良恶性心包积液的方法及效果。方法 100例心包积液患者,置管前做常规心脏彩超,确定心包积液的程度,并设定穿刺路线,避开肋骨为穿刺进针点,超声引导下局麻置入引流管。结果 100例心包积液患者均置管成功,成功率100%,无并发症发生。结论超声引导下心包穿刺置管方法安全、可靠、有效,值得推广应用。     

PTC穿刺针在心包积液穿刺置管引流中的应用

目的探讨超声引导下PTC穿刺针经皮穿刺心包积液并置管引流心包积液的疗效及安全性。方法 55例中等量到大量心包积液的患者在超声引导下PTC穿刺针经皮穿刺心包积液并置管行心包持续引流。结果 55例患者均置管成功,留置时间(5～16 d)平均8 d,均无组织脏器损伤及感染。10例发生导管堵塞,经肝素生理盐水冲洗后再通。结论超声引导下PTC穿刺针经皮穿刺心包积液并置管引流术是一种更安全、有效的治疗心包积液方法。     

B超引导心包穿刺置管药物灌注治疗恶性心包积液37例

目的 探讨安全的心包穿刺置管引流方法，及观察药物局部灌注治疗恶性心包积液。方法 采用B超定向、定位及实时指导下行心包穿刺置入引流管，引流心包腔内积液，并经导管注入化疗及免疫药物治疗。结果 37例恶性心包积液行41例次的治疗，其有效率(CR PR)100％，其中完全缓解率92％。无心肌损伤，心跳骤停，血流动力学明显改变等严重并发症。腔内治疗毒副作用轻微。可长时间保留心包内引流。结论 本方法可安全、高效的治疗恶性心包积液。     

中心静脉导管对先天性心脏病术后胸腔积液应用价值

目的 探讨中心静脉导管引流先天性心脏病术后胸腔积液的效果和安全性。方法 选取经胸片和超声诊断为胸腔积液的29例先天性心脏病术后病儿。通过床旁超声先行定位,局麻下置入中心静脉导管,观察治疗效果、不良反应,评估操作的安全性。结果 29例病儿均一次成功置入中心静脉导管,留置引流时间为3～24 d,累计引流量120～3 300 mL。所有病儿耐受性良好,临床症状明显改善,胸腔积液消失或减少,有效率达100%,未出现出血、气胸、导管脱出、感染、堵塞等相关并发症。结论 中心静脉导管引流先天性心脏病术后胸腔积液,具有简便、安全、有效、微创等特点,有较高的临床应用价值。     

超声定位下应用中心静脉导管引流治疗心包积液的护理体会

目的介绍超声定位下心包穿刺置管引流术的护理体会。方法对26例中大量的心包积液患者术前经二维超声心动图定位,应用中心静脉导管引流治疗心包积液,术前、术中、术后护理进行系统的观察、护理。结果 26例病例均一次穿刺置管成功,导管留置时间2~5 d,引流液量300~3 800 mL,心包积液引流彻底,未出现严重并发症。结论该方法简单、安全、可靠、疗效好。     

New approaches to the management and treatment of malignant pericardial effusion

The purpose of this study was the evaluation of the effectiveness of intrapericardial administration of tetracycline, 5-fluorouracil and cisplatin in patients with recurrent malignant pericardial effusion. In 33 cases with malignant pericardial effusion 46 pericardiocenteses under two-dimensional echo-cardiography were performed. No complications were observed after this procedure. Pericardiocentesis was followed by catheterization of the pericardial space for a mean period of 15 days (range 1–64). In 4 cases bacterial pericarditis was observed during catheterization. The mean volume of the pericardial fluid was 2.4 l (range 0.4–13 l). In cases with bloody pericardial fluid thePO₂,PCO₂ and pH of the fluid were estimated and the results compared with the values for venous blood obtained from the upper limbs. Highly statistically significant differences were documented. Twenty cases of malignant pericardial effusion were treated with direct pericardial administration of cisplatin, 3 with 5-fluorouracil and 2 with tetracycline. Good results (no fluid reaccumulation) were observed only after cisplatin therapy. We conclude that pericardiocentesis performed under two-dimensional echo cardiography, followed by pericardial catheterization and direct pericardial treatment with cisplatin are the methods of choice in cases with malignant pericardial effusion. In cases with bloody pericardial fluidPO₂,PCO₂ and pH analysis can be useful to differentiate the source of the bloody fluid (blood or bloody fluid).     

Outcomes of primary and secondary treatment of pericardial effusion in patients with malignancy

OBJECTIVE: To evaluate the treatment strategies for primary and secondary management of malignancy-related pericardial effusions. PATIENTS AND METHODS: Retrospective review of Mayo Clinic Rochester charts and external records of patients with pericardial effusion associated with malignant disease who required treatment between February 1979 and June 1998 was performed. Telephone interviews with patients, their families, or their physicians were conducted to determine the outcomes of treatment. Recurrence of pericardial effusion and survival were the main outcome measures. RESULTS: Of 1002 consecutive pericardiocenteses performed during the period under study, 341 were performed in 275 patients with confirmed malignant disease. Patients were followed up for a minimum of 190 days, unless death occurred first. Of 275 patients, recurrence of pericardial effusion or persistent drainage necessitated secondary management in 59 (43 of 118 simple pericardiocenteses, 16 of 139 pericardiocenteses with extended catheter drainage, and 0 of 18 pericardial surgery following temporizing pericardiocentesis). Recurrence was strongly and independently predicted by absence of pericardial catheter for extended drainage, large effusion size, and emergency procedures. Recurrence after secondary management occurred in 12 patients: 11 underwent successful pericardiocentesis with extended catheter drainage, and 1 had pericardial surgery. Median survival of the cohort was 135 days, and 26% survived the first year after diagnosis of pericardial effusion. Male sex, positive fluid cytology for malignant cells, lung cancer, and clinical presentation of tamponade or hemodynamic collapse were independently associated with poor survival. CONCLUSION: Echocardiographically guided pericardiocentesis with extended catheter drainage appears to be safe and effective for both primary and secondary management of pericardial effusion in patients with malignancy.     

大量胸腔积液中心静脉导管引流并腔内药物治疗的护理

目的探讨中心静脉导管在治疗胸腔积液及胸腔化疗时的作用和护理要点。方法对20例胸腔积液患者在B超定位下行胸腔穿刺并留置中心静脉导管,间断引流或抽吸胸腔积液后注入化疗药物,做好导管护理,观察护理效果。结果20例患者均成功置管并顺利完成治疗,置管时间5--21d,无1例出现气胸、导管脱落、感染等严重并发症。结论置管后定期换药,保持引流管通畅,防止导管扭曲、脱落是成功治疗的关键,规范化护理大大减轻了患者的痛苦。     

超声监测经皮心包内多部位活检,引流和灌洗治疗

本文介绍应用介入性超声技术在原因不明的心包积液诊断和治疗取得显著效果。３７例患者经心包多部位活检明确病因诊断章取义务兵例，病理论断率８６．３％，比以往常规心包穿刺术诊断率提高了６０％以上；２１例急慢性心包填塞的患者经过导管引流得到完全缓解；根据病因在超声控制引流完全后给予心包腔内灌洗治疗，使数月、数年不能治愈的心包积液变为３－－１０天完成治疗，全部病例复查随访三个月无一例复发。本文详细描述了操作方     

Pericardiocentesis.

Cardiac tamponade is a life-threatening condition resulting from compression of the cardiac chambers by a pericardial effusion. The principal cause of pericardial effusion is malignant disease of the pericardium, but infectious causes and cardiac trauma are common as well. The patient with cardiac tamponade demonstrates an abnormal pulsus paradoxus, and clinical signs of shock and impending cardiovascular collapse occur with very severe cardiac compression. Relief of the increased intrapericardial pressure is mandatory to establish adequate cardiac output. The definitive treatment of cardiac tamponade is emergent removal of enough pericardial fluid to acutely lower intrapericardial pressure. Echocardiographic guidance may be used if immediately available, but is not required to perform pericardiocentesis in a critical situation. Placement of a pulmonary artery catheter prior to pericardiocentesis is not indicated in cardiac tamponade. Once cardiac output and tissue perfusion have been restored, further drainage procedures such as pericardial catheter placement or surgical drainage are indicated. Therapeutic measures to address the underlying disease process should be initiated after pericardial drainage is accomplished.     

Real-time cardiovascular magnetic resonance subxiphoid pericardial access and pericardiocentesis using off-the-shelf devices in swine

Background

Needle access or drainage of pericardial effusion, especially when small, entails risk of bystander tissue injury or operator uncertainty about proposed trajectories. Cardiovascular magnetic resonance (CMR) might allow enhanced imaging guidance.

Methods and results

We used real-time CMR to guide subxiphoid pericardial access in naïve swine using commercial 18G titanium puncture needles, which were exchanged for pericardial catheters. To test the value of CMR needle pericardiocentesis, we also created intentional pericardial effusions of a range of volumes, via a separate transvenous-transatrial catheter. We performed these procedures in 12 animals.Pericardiocentesis was performed in 2:47 ± 1:43 minutes; pericardial access was performed in 1:40 ± 4:34 minutes. The procedure was successful in all animals. Moderate and large effusions required only one needle pass. There were no complications, including pleural, hepatic or myocardial transit.

Conclusions

CMR guided pericardiocentesis is attractive because the large field of view and soft tissue imaging depict global anatomic context in arbitrary planes, and allow the operator to plan trajectories that limit inadvertent bystander tissue injury. More important, CMR provides continuous visualization of the needle and target throughout the procedure. Using even passive needle devices, CMR enabled rapid pericardial needle access and drainage. We believe this experience supports clinical testing of real-time CMR guided needle access or drainage of the pericardial space. We suspect this would be especially helpful in “difficult” pericardial access, for example, in distorted thoracic anatomy or loculated effusion.