中心静脉导管心包腔置管引流并腔内化疗治疗恶性心包积液疗效分析

目的探讨恶性心包积液经心包穿刺引流并腔内化疗的疗效及不良反应。方法23例恶性心包积液采用B超定位引导下行心包穿刺置管术引流心包积液，并腔内注药。结果穿刺成功率100％；腔内化疗1次积液消失者3例，化疗2次积液消失10例，化疗3次积液消失4例；完全缓解73．9％(17／23)，部分缓解13．0％(3／23)，总有效率为87．0％(20／23)，无效为13．0％(3／23)。结论B超引导下心包腔内置管引流并腔内化疗治疗恶性心包积液，操作简单，安全，副作用少，疗效好。     

心包猪尾导管和胸腔10F导管引流并化疗治疗多发性浆膜腔炎(附9例临床报道)

目的观察猪尾导管心包引流联合10F小导管胸腔引流或穿刺抽水治疗9例多发性浆膜腔炎的疗效。方法通过经皮猪尾导管心包引流救治心包填塞，并留置导管，多次腔内化疗治疗心包积液；经皮胸腔引流或穿刺抽水并局部化疗治疗双侧胸腔积液；肿瘤患者常规化疗控制肿瘤发展。结果9例重症多发性浆膜腔炎患者中，7例心包及胸腔积液均基本获得临床治愈(心包积液和胸腔积液基本消失并不再生长)，临床治愈率77．8％，肌力及心功能恢复良好。恶性胸腔积液患者不但生存期延长6～12个月以上，而且，生存质量明显提高，实现生活自理；1例结核性多发性浆膜腔炎患者完全治愈；2例病情极重，未能完全控制心包积液而衰竭死亡。结论猪尾导管心包引流联合胸腔导管引流并化疗可治疗恶性或结核性多发性浆膜腔炎，方法可靠，可救治心包填塞，值得临床推广。     

中心静脉导管用于心包积液引流的护理

恶性心包积液是恶性肿瘤常见的并发症之一，多见于肺癌晚期病人。局部治疗包括反复心包穿刺排液、心包腔内化疗或免疫制剂治疗。此方法因多次穿刺，病人倍感痛苦，且感染发生率高。我科自2004年1月-2006年8月采用中心静脉导管穿刺并留置于心包腔内，间断引流心包积液并注入免疫制剂治疗恶性心包积液，疗效满意。现报告如下。     

肿瘤性心包积液的介入性治疗

目的：阐明经剑突下穿刺猪尾导管心包引流并腔内化疗治疗恶性心包积液的有效性、安全性和实用性。方法：经剑突下心包穿刺置人猪尾导管于心包腔内间断引流。首次抽液量在500～600ml;24小时后抽液800～1000ml并腔内洼射顺铂20mg;48小时抽完剩余积液再予以顺铂20mg腔内注射。引流间隙导管腔内灌注生理盐水,未端接一小三通并置于三不通状态。术后跟踪随访至患死于原发病。结果：13例患均为恶性心包积液。经治疗后心包积液消失8例;残余少量积液5例,但超声心动图随访发现积液无增多趋势。穿刺置管过程中无一例发生严重并发症。导管引流过程中,无一例出现导管滑脱、堵塞及心包腔内感染。随访发现无一例患死于心包填塞。结论：经剑突下穿刺猪尾导管心包引流并腔内化疗治疗恶性心包积液可减轻恶性心包积液患的痛苦,延长生命,是一有效、安全和实用的方法,值得临床推广使用。     

白细胞介素-2、顺铂联合治疗恶性心包积液——附25例报告

目的观察微导管持续心包引流并注入白细胞介素-2和水剂顺铂对恶性心包积液的疗效。方法25例恶性心包积液患者先行心包腔穿刺微导管引流后，采用心包腔内注射白细胞介素-2500万，水剂顺铂50mg治疗恶性心包积液 为减轻不良反应，同时注入2％利多卡因5ml和地塞米松10mg。结果按WHO(世界卫生组织)疗效标准及Msrio的心包积液控制标准疗效分为CR、PR、(P)NC。25例中完全缓解7例占28％，部分缓解12例，占48％，3例伴有上腔静脉综合征，1例合并双侧胸腔积液，1例为肝转移合并肝硬化，1例为多发转移癌全身衰竭，治疗效果不理想共6例，占据24％。总有效率为76％。结论在持续微导管对恶性心包积液引流后注入白细胞介素-2和水剂顺铂是治疗恶性心包积液的有效方法。能改善患者生存质量，延缓晚期恶性肿瘤病人生存期，减轻其痛苦。     

置管引流治疗恶性心包积液18例

目的:探讨恶性心包积液的治疗和疗效。方法:对18例恶性心包积液置管引流及腔内化疗的回顾性分析。 结果:治疗总有效率为88.9%,无严重不良反应或并发症。结论:置管引流及腔内化疗治疗恶性心包积液疗效较 好。     

心包穿刺置管引流并腔内化疗治疗恶性心包积液病人的护理

恶性心包积液是晚期肿瘤的并发症之一，不但增加病人的痛苦，而且威胁病人的生命。我科从2003年开始对9例恶性心包积液病人行心包穿刺置管引流并腔内化疗，同时辅以积极的综合治疗和精心护珲，取得了良好的效果。现报告如下。     

超声引导下心包腔置管引流治疗恶性心包积液

恶性心包积液为恶性肿瘤患者常见的并发症,严重影响患者的生命安全。心包穿刺是一项有危险的操作技术,术中极易因恶性心率失常,冠状动脉损伤,心包填塞等引起患者死亡或导致其气胸等严重并发症,致命性并发症发生率高达10％-20％^[1]。本研究采用超声引导下置入中心静脉导管引流及心包腔内化疗术对22例恶性心包积液患者进行治疗,     

心包穿刺置管引流治疗恶性心包积液8例的护理

目的：探讨心包穿刺置管引流治疗恶性心包积液的护理。方法：对8例恶性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：8名患者无1例发生心包内继发感染和并发症。结论：心包穿刺置管引流是治疗恶性心包积液的安全有效的方法,护士应加强置管前后的观察和护理,以增进恶性心包积液患者的治疗效果,提高患者的生存质量。     

恶性心包积液置管引流并VP-16联合DDP腔内注射22例分析

目的观察心包腔内留置中心静脉导管引流并灌注足叶乙甙（VP-16）、顺铂（DDP）治疗恶性心包积液的疗效。方法 22例恶性心包积液患者应用中心静脉导管心穿刺置管引流,将VP-16及DDP稀释后注入心包腔内治疗。结果完全缓解（CR）12例,部分解（PR）8例,总有效率（CR＋PR）为90.9%,其不良反应主要为轻度消化道反应,患者可耐受。结论该方法简便、安全,有效率高,不良反应低,能有效控制恶性心包积液。     

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.     

介入性超声下引导心包穿刺置管治疗心包积液的临床探讨

目的探讨超声引导下经皮心包穿刺置管持续引流心包积液的临床应用。方法在100例心包积液患者心尖部或心前区置入中心静脉导管引流。结果 100例心包积液病人全部安全有效置管成功,得到有效救治,25例心脏压塞患者引流后症状迅速缓解。置管可长期保留（5~16 d）,操作并发症少。结论超声引导下经皮心包积液置管法简单、安全、有效,便于临床应用。     

超声引导下中心静脉导管置管引流治疗恶性心包积液的临床价值

目的 评价在超声引导下应用中心静脉导管置管引流并注入相应化疗药治疗恶性心包积液的临床价值.方法 41例恶性心包积液患者,于超声实时引导下行心包腔穿刺置入中心静脉导管,引流积液并注射相应化疗药.结果 所有患者均一次穿刺置管成功,胸闷、呼吸困难等心包填塞症状缓解,无心跳骤停及心律失常发生,主要并发症为引流管脱出等.结论 超...     

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.     

A simple method for continuous pericardial drainage

Needle pericardiocentesis is performed routinely for relief of symptoms in patients with pericardial effusion and cardiac tamponade. In many patients however, reaccumulation of fluid requires further aspiration or surgical drainage, occasionally as a matter of urgency. Both procedures carry significant risks which may be avoided by insertion of an indwelling catheter. The Viggo subclavian cannula proves ideal for prolonged drainage of pericardial effusions and for relief of tamponade in an emergency situation. Introduction into the pericardium is simple, safe, and can be performed quickly without specialised equipment. This procedure is described and illustrated in patients with tuberculous and rheumatoid pericarditis.     

Consecutive 1127 therapeutic echocardiographically guided pericardiocenteses: clinical profile,practice patterns,and outcomes spanning 21 years

OBJECTIVES: To evaluate consecutive therapeutic echocardiographically (echo)-guided pericardiocenteses performed at Mayo Clinic, Rochester, Minn, from 1979 to 2000 and to determine whether patient profiles, practice patterns, and outcomes have changed over time. PATIENTS AND METHODS: Consecutive echo-guided pericardiocenteses performed between February 1, 1979, and January 31, 2000, for treatment of clinically significant pericardial effusions were identified in the Mayo Clinic Echocardiographic-guided Pericardiocentesis Registry. The medical records of these patients were examined, and a follow-up survey was conducted. Clinical profiles, echocardiographic findings, procedural details, and outcomes were determined for 3 periods: February 1, 1979, through January 31, 1986; February 1, 1986, through January 31, 1993; and February 1, 1993, through January 31, 2000. RESULTS: During the 21-year study period, 1127 therapeutic echo-guided pericardiocenteses were performed in 977 patients. The mean +/- SD age at pericardiocentesis increased from 49+/-14 years in period 1 to 57+/-14 years in period 3. In recent years, cardiothoracic surgery replaced malignancy as the leading cause of an effusion requiring pericardiocentesis and together with malignancy and perforation from catheter-based procedures accounted for nearly 70% of all pericardiocenteses performed. The procedural success rate was 97% overall, with a total complication rate of 4.7% (major, 1.2%; minor, 3.5%). These rates did not change significantly over time. The use of a pericardial catheter for extended drainage increased from 23% in period 1 to 75% in period 3 (P<.001), whereas rates of effusion recurrence and pericardial surgery decreased significantly (P<.001). CONCLUSIONS: The profile of patients presenting with clinically significant pericardial effusion has changed over time. Increasing numbers of older patients and those who have undergone cardiothoracic surgery or catheter-based procedures develop effusions that can be rapidly, safely, and effectively managed with echo-guided pericardiocentesis. Extended drainage with use of a pericardial catheter has become standard practice, and concomitantly, recurrence rates and need for surgical management have decreased considerably.     

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。     

中心静脉导管留置引流并胸腔内灌注顺铂、天地欣治疗恶性胸腔积液68例分析

目的分析中心静脉导管留置引流并胸腔内灌注顺铂、注射用香茹多糖（天地欣）治疗恶性胸腔积液的疗效及不良反应。方法68例恶性胸腔积液患者经中心静脉导管留置引流并胸腔内灌注顺铂、天地欣治疗,分析临床转归情况。结果68例恶性胸腔积液经中心静脉导管留置引流并胸腔内灌注顺铂、天地欣治疗后,临床疗效：完全吸收（CA）24例占35．3％、部分吸收（PA）30例占44．1％、无效（NA）14例占20．6％。结论中心静脉导管留置引流并胸腔内灌注天地欣联合顺铂治疗恶性胸腔积液的疗效较好。     

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。     

微创置管胸腔引流与常规胸腔穿刺治疗恶性胸腔积液的效果观察

目的观察微创置管胸腔闭式引流与常规胸腔穿刺后注药治疗恶性胸腔积液的临床疗效。方法将58例恶性胸腔积液患者随机分成A（n=30）、B（n=28）2组,分别进行微创置管闭式引流和常规胸腔穿刺,并均于胸腔内注入化疗药物。结果A组胸腔积液控制的总有效率为83．3％,明显优于B组的57．1％（P〈0．05）。结论应用微创置管引流恶性胸腔积液操作安全、简便,能最大限度地排净胸腔积液,对控制癌性胸腔积液有较好的疗效,能显著改善患者生活质量。