中心静脉导管置管引流治疗心包积液38例

目的观察应用中心静脉导管置管引流治疗心包积液的安全性、可行性.方法 38例心包积液病人均应用Seldinger法从剑突下穿刺,将单腔中心静脉导管置入心包腔引流.结果 38例均穿刺成功,引流管留置时间3 d～21 d,平均5.7 d,引流积液量300 mL～3 200 mL,平均634 mL,无明显并发症.结论中心静脉导管经皮穿刺置管引流可用于治疗心包积液.     

心包穿刺留置中心静脉导管引流心包积液

目的　探讨采用心包穿刺留置中心静脉导管引流心包积液的方法、引流液量控制和引流的体位。方法　患者半坐位或平卧位 ,根据超声心动图定位的穿刺点、穿刺深度及方向 ,1 6例采用剑突下进针 ,36例采取左侧胸壁进针 ,将中心静脉导管置入心包腔内 ,连接无菌引流袋引流心包积液。结果　 52例心包积液患者心包穿刺均获得成功 ,无明显并发症 ,52例患者引流管平均留置时间 1 4 .68± 4.66(8～ 48) d,平均引流量为 790±2 78(32 0～ 2 90 0 ) ml,心包穿刺引流后 ,心包填塞症状缓解或消失 ,心率显著减慢、收缩压和平均压明显升高 (P<0 .0 5)。结论　采用超声心动图定位 ,床边行心包穿刺 ,置入中心静脉导管引流中等量和大量心包积液安全可靠 ,引流彻底 ,疗效可靠 ,无明显并发症。     

Seldinger导管法心包穿刺引流心包积液38例

目的：评价Seldinger导管法心包穿刺置管引流治疗心包积液的临床疗效及安全性。方法：38例心包积液患在心尖部、左侧第5-6肋间隙心浊音界内1.5-2cm处穿刺心包，置入单腔中心静脉导管，观察患的心包积液引流及临床情况。结果：全部病例均完全置管引流，临床症状明显改善。所有患术中、术后未发生严重并发症，无1例并发感染。结论：Seldinger技术穿刺心包，置入单腔中静导管引流是安全、简便、实用的治疗方法。     

B超引导下中心静脉导管留置引流心包积液的临床探讨

目的 探讨床旁B超引导下中心静脉导管留置引流术在心包积液诊治中的临床应用.方法 采用Seldinger法,在床旁B超定位下,于心尖部或剑下穿刺留置中心静脉导管引流心包积液.结果 穿刺及急救心包填塞成功率高.导管留置 3 d～23 d不等,无严重并发症.结论 B超引导下,中心静脉导管留置引流心包积液,具有安全、方便,有效等优点.     

中心静脉留置导管在心包积液治疗中的应用

目的：探讨中心静脉留置导管引流心包积液的效果。方法：用改良的Seldinger法经皮穿刺，将中心静脉留置导管置入心包腔内，进行引流、抽液等治疗。结果：25例全部成功，引流心包液300ml～2800ml，留置导管2～20天，无并发症。结论：该法有创伤小，使用简便，减少痛苦等优点。     

Seldinger技术指导心包穿刺置管引流治疗心包积液

目的 评价Seldinger技术指导心包穿刺置管引流治疗中至大量心包积液的疗效及安全性。方法 中到大量心包积液48例,在超声心动图定位下,采用Seldinger技术,经皮穿刺心包腔并内置深静脉留置导管进行持续或间断引流心包积液。结果 48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、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。留置时间时间5～42（10．7±4．7）d,平均引流量为280～1750（590±160）ml。结论 采用Seldinger技术心包穿刺置管引流治疗中至大量心包积液,方法简单,安全有效,成功率高,可替代传统穿刺方法。     

超声下Seldinger技术心包穿刺置管引流治疗急性心包填塞的临床观察

目的　评价超声下 Seldinger技术心包穿刺置管引流治疗急性心包填塞的疗效及安全性。方法　 16例中到大量心包积液发生急性心包填塞患者 ,在超声心动图引导下 ,采用 Seldinger技术 ,经皮穿刺心包腔内置中心静脉导管进行间断抽液。结果　 16例患者均一次穿刺成功 ,穿刺成功时间 2～ 5 min。无 1例出现心肌或其它脏器损伤 ,4例出现抽吸时导管堵塞 ,用生理盐水冲洗后通畅 ,1例出现局限性皮下渗液 ,1例穿刺处皮肤轻度红肿 ,经处理后消失。留置导管时间一般 2～ 14 d,最长 2月余。结论　超声下Seldinger技术心包穿刺置入中心静脉导管引流治疗急性心包填塞 ,方法简单 ,能安全有效缓解心包填塞症状 ,成功率高 ,可替代传统穿刺方法     

心包腔置管引流治疗结核性心包积液安全性探讨

目的探讨心包腔置入中心静脉导管持续引流治疗结核性心包积液的安全性、有效性。方法采用Seldinger技术将中心静脉导管置入心包腔引流心包积液。结果26例患者均成功引流心包积液,术后症状迅速缓解。结论心包腔置管持续引流治疗结核性心包积液疗效满意,并发症少,患者耐受性好,医疗费用少,是安全、方便、有效的理想方法。     

经皮心包穿刺置管持续引流治疗心包积液30例

目的 探讨经皮心包穿刺置管持续引流心包积液的疗效观察及安全性。方 法30例中等量到大量心包积液的病人在超声引导下穿刺置管行心包持续引流（采用中心静脉导管）。结果 30例病人均置管成功，留置时间平均10d（5d-26d），均无组织脏器损伤及感染。2例发生导管堵塞，经肝素生理盐水冲洗后再通，置管1～2周复查B超若心包积液消失则拔出导管。结论 经皮心包穿刺置管持续引流是一种创伤小、操作简便、安全、有效治疗心包积液的方法。     

心包穿刺置管引流治疗心包积液的护理

目的探讨心包经皮穿刺置管引流治疗心包积液的护理。方法对10例心包积液患者应用中心静脉导管进行心包穿刺并置管引流,加强术前护理,术中配合,置管后做好体位、留置导管、心理及生活方面的护理指导并密切观察病情。结果10例心包积液患者经皮穿刺置管术均穿刺成功,导管留置时间5～20d,中位时间12d。置管后2例出现穿刺处渗液,1例出现导管松脱,2例发生导管堵塞。结论心包经皮穿刺置管引流是治疗心包积液的安全、有效的方法,做好术前、术中、术后观察和护理,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。     

48例B超引导下心包穿刺置管在心包积液诊治中的临床应用

目的探讨B超引导下经皮心包穿刺置管持续引流心包积液的疗效及安全性。方法对48例心包积液病人行B超检查,并在B超引导下进行置入中心静脉导管引流。结果 48例心包积液病人全部安全有效、置管成功。症状迅速缓解,可长期保留（4～16天）。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。     

心包腔容积—压力关系的临床研究

１６ 例中到大量心包积液患者在Ｘ线下使用Ｓｅｌｄｉｎｇｅｒ法,经剑突下穿刺心包放置７Ｆ导鞘,心包造影,定量抽液及压力测定。资料完整的１５ 例患者显示:心包腔内压力与心包积液量无相关性。有心包填塞症状者,当抽液量达到１５０ ｍ ｌ时,心包内压力下降曲线最为陡峭:幅度最大,而以后随积液量减少,压力下降徐缓。当抽液到２５０ ｍ ｌ时心包腔舒张压在０．４０ ｋＰａ～－ １．４６ ｋＰａ 之间,大多数低于文献报道的右房舒张压。在积液基本抽完时,１２ 例心包腔平均压在０～－ １．３３ ｋＰａ之间,最低可达－ ２．０ ｋＰａ,与胸膜腔压近似。１ 例有肺气肿的老年患者和２ 例有胸腔积液者压力在０．１３ ｋＰａ～０．５３ ｋＰａ之间     

Pericardiocentesis afrer heart surgery--our experience

Pericardial effusion after cardiac surgery is common, but only in a small part of patients it has progressive character and cardiac tamponade occurs. Accurate diagnosis and well-timed pericardiocentesis are necessary to effective management of this life threatening complication. The study aimed at presentation of our centre outcomes of echocardiographically-guided pericardiocentesis in patients after cardiac surgery. METHODS: Between December 2005 and November 2007, 2,232 patients underwent open-heart surgery in our centre. At 48 (2.2%) of them pericardiocentesis for clinically significant pericardial effusion was performed. RESULTS: Pericardiocentesis was significantly more frequent after valve surgery (7.1%, p < 0.001), aortic root surgery (8.2%, p < 0.001) and surgical ablation of atrial fibrillation (6.6%, p < 0.001), i.e. in patients who had received postoperative anticoagulation therapy. Echo-guided pericardiocentesis was technically and therapeutically successful in 100% of cases and no complications were registered. The time elapsed between surgery and puncture was in range 6 to 80 days (median, 13 days). The median volume initially aspirated was 450 ml (range, 50 to 1,550 ml). Forty five patients (93.8%) had extended catheter drainage with active suction, the median duration of the drainage was 1 day (range, 1 to 6 days), the mean volume of catheter drainage was 328 ml (median, 145 ml; range, 20 to 2,950 ml). Four patients (8.3%) required repeated pericardiocenteses because of recurrence of significant pericadial effusion. Extended pericardial catheter drainage (after initial evacuation of the effusion) was associated with a significant reduction of recurrence of significant pericadial effusion and with lower probability of repeated pericardiocentesis. We can conclude, echo-guided pericardiocentesis was effective and safe method for primary treatment of postoperative pericardial effusions.     

Medical management of malignant pericardial effusion by tetracycline sclerosis

Fifty-eight patients with malignant pericardial effusion were seen from 1979 to 1986. A Kifa catheter was inserted into the pericardial sac and allowed to drain for 12 to 24 hours during electrocardiographic monitoring. Lidocaine hydrochloride, 100 mg, was instilled intrapericardially, followed by tetracycline hydrochloride, 500 to 1,000 mg, in 20 ml of normal saline solution. The catheter was clamped for 1 to 2 hours and then reopened. This procedure was repeated daily until the net drainage was less than 25 ml/24 hours. There were 22 male and 36 female patients (median age 58 years). The primary malignancy included lung (27 patients), breast (16 patients), stomach (3 patients), adenocarcinoma of unknown primary (7 patients), mesothelioma (2 patients) and chronic granulocytic leukemia, ovary and lymphoma (1 patient each). Fifty-six patients received 1 to 5 tetracycline instillations. In 1 patient, the catheter could not be inserted and in another, clotting occurred within the catheter before injection of tetracycline. Complications included transient atrial arrhythmias (5 patients), pain after injection (9 patients) and temperature higher than 37.5 degrees C (5 patients). One patient had a cardiac arrest during pericardiocentesis. Forty-three patients (74%) had control of their effusions for longer than 30 days (median survival 168 days, range 30 to 1,149+), and 5 patients (9%) died before 30 days without effusion. Eight patients (14%) did not achieve control. One declined further therapy after 1 instillation, and 3 died within 6 days with progressive malignancy. One patient had persistent drainage after 3 instillations, and 3 had reaccumulation of fluid 2, 6 and 27 days after catheter removal.(ABSTRACT TRUNCATED AT 250 WORDS)     

Percutaneous pericardial catheter drainage: report of 42 consecutive cases

Test results of 42 consecutive patients with pericardial effusion treated with percutaneous pericardial drainage were analyzed. Intermittent (79%) or continuous (21%) drainage through a 60-cm pigtail catheter (No. 6Fr to 8Fr) was used. Clinical indications were urgent or semiurgent treatment of large (38%), life-threatening (24%), recurrent (21%) or acute (traumatic) (17%) pericardial effusion. Sixteen patients had a malignant cause for the effusion. Mean duration of use of the indwelling pericardial catheter was 3.5 days (range less than 1 day to 19 days). Two of the 9 catheters in patients on continuous drainage but only 1 of 33 catheters in patients on intermittent drainage became occluded. There was only 1 possible infective complication. Six patients had subsequent elective surgical intervention for persistent or recurrent effusion. Placement of an indwelling pericardial catheter guided by 2-dimensional echocardiography is safe and effective for initial treatment of selected pericardial effusions.     

Evaluation of children with a large pericardial effusion and cardiac tamponade

OBJECTIVES: Large pericardial effusions and cardiac tamponade are rare in childhood.The aim of this study was to evaluate the aetiological factors and clinical findings of large pericardial effusion and cardiac tamponade in children. METHODS: We reviewed retrospectively the records of 10 (6 male, 4 female) patients (mean age: 8.05 +/- 4.4 y) with the diagnosis of large pericardial effusion and cardiac tamponade requiring pericardiocentesis and pericardial drainage between 2002 and 2004. RESULTS: After extensive diagnostic investigation we detected that three patients had tuberculosis, one patient had uraemic pericarditis; one patient had bacterial pericarditis; one patient had post-pericardiotomy syndrome; two patients had malignancy and two patients had no identifiable aetiology. Echocardiography-guided percutaneous pericardial puncture and pigtail catheter placement is safe and effective for initial treatment of patients with large pericardial effusion and cardiac tamponade and in most cases, initial assessment with clinical, serologic, and radiologic investigation and careful follow-up can reveal the aetiology. CONCLUSIONS: Although tuberculosis is rare in industrialized countries, in developing countries it remains one of the most important causes of large pericardial effusion and should be investigated and excluded in each patient.     

超声心动图监测经皮介入诊断治疗心包积液

目的：原因不明心包积液是临床诊断治疗的难题。本文旨在探讨超声心动图监测下经皮心包多部位活检、引流、灌洗诊断治疗此病的效果。方法：８０例病人在超声心动图监测下经皮穿刺用塞林格技术放入止血鞘，通过鞘内用活检镜行多部位心包活检。标本经病理常规及免疫组化（Ｋｅｒａｔｉｎ法）在光镜及电镜下检查经病因学包括多聚酶链反应（ＰＣＲ）查出病因。经鞘内用猪尾导管引流出所有积液，进行３～１４天病因灌洗治疗，然后拔出导管。结果：病因诊断率达８６％以上，经３～６个月随访，治愈率达９０％，无明显并发症发生。结论：新方法将介入技术应用于心包积液，集诊断、治疗于一体，较以往心包穿刺等方法有明显优越性。此法安全，适用于各级医院推广应用，国内外尚无同类方法报道。     

心包积液持续导管引流穿刺部位的新选择

目的　探讨经胸骨左缘第 3、4肋间穿刺放置心包积液引流导管的可行性和安全性。方法　应用二维超声心动图 ( 2DE) ,探测 38例中到大量心包积液患者剑突下、心尖部及胸骨左缘第 3、4肋间距胸骨左缘 2cm处 3个部位的舒张期最大积液厚度和预定进针深度 ;在 2DE引导下 ,以胸骨左缘第 3、4肋间为穿刺点 ,留置导管引流心包积液。结果　 2DE探测 3个部位的舒张期最大积液厚度差异无显著性 ,胸骨左缘第 3、4肋间处预定进针深度最小 ;38例患者均一次穿刺、留置导管成功 ,其中36例 ( 94 8% )经超声证实引流导管位于后心包。无穿刺相关并发症 ,无导管脱出心包腔及积液渗漏至胸腔或皮下 ,1例于放置引流导管后第 3天发生神经介导性晕厥。结论　经胸骨左缘第 3、4肋间途径行心包引流导管留置术安全有效、操作简便 ,优于剑突下和心尖部途径     

Etiology and prognostic implications of a large pericardial effusion in men

To assess the etiology and prognosis of a large pericardial effusion, we reviewed 25 consecutive patients who presented with a large pericardial effusion and underwent a drainage procedure. Large pericardial effusion was defined as: (1) an echo-free space greater than or equal to 10 mm anteriorly and posteriorly by M-mode echocardiography and (2) removal of greater than or equal to 350 ml of fluid at pericardial drainage. The etiologies of large pericardial effusion were: neoplastic (36%), idiopathic (32%), uremic (20%), postmyocardial infarction (8%), and acute rheumatic fever (4%). Of our patients, 44% presented with cardiac tamponade, while 25% of patients with idiopathic pericarditis had hemorrhage effusion and cardiac tamponade. At follow-up, 37 +/- 17 months after pericardial drainage, 68% had died from complications of their underlying disease. There were no deaths attributed to pericardial disease. While 88% of patients with idiopathic large pericardial effusion were alive at follow-up, none of the neoplastic large pericardial effusion patients survived longer than 5 months after initial pericardial drainage (p less than 0.001). Additionally, the survival of patients with uremic large pericardial effusion was better than patients with neoplastic large pericardial effusion (p less than 0.05). We conclude: (1) neoplastic, idiopathic, and uremic pericarditis are the most common causes of large pericardial effusion in men, (2) idiopathic pericarditis can be hemorrhagic and cause cardiac tamponade, and (3) the prognosis of large pericardial effusion is related to patients' underlying disease.