心脏介入治疗并发心脏压塞的临床分析

目的:总结心脏介入治疗并发心脏压塞的临床特点、诊断、治疗和结果。方法:分析1998年1月~2005年6月进行心脏介入治疗发生心脏压塞的12例患者资料。结果:12例患者发生心脏压塞,其中起搏器置入术2例,射频消融术2例,冠心病介入治疗术3例,房间隔缺损封堵术1例,上腔静脉滤器置入术1例,冠状动脉瘘造影1例,肥厚型心肌病行NOGA标测1例,心包穿刺引流术1例。早发心脏压塞6例,迟发心脏压塞6例;早发心脏压塞多表现为术中血压、心率突然下降,透视下心影外缘出现透亮环,心脏搏动减弱;迟发心脏压塞患者可表现为血压下降、心率增快、休克。救治成功10例,死亡2例。结论:强化诊断意识、早期识别心脏压塞、及时行心包穿刺引流、外科处理是抢救的关键。

Manifestation and management of cardiac tamponade in cardiac interventional therapy

Objective:To summarize the clinical charaterstics, diagnose treatment consequences of the cardiac tamponade during cardiac interventional procedure. Method:Retrospective analysis was made according to 12 patients with cardiac tamponade during the cardiac interventional procedures from January 1998 to June 2005. Result:Among all the 12 patients with Cardiac tamporade, there were 2 from pacemaker insertion, 2 from radiofrequency catheter ablation ,3 from percutaneous coronary intervention (PCI),1 from closure of atrial septal with Amplaty closure service, 1 from coronary artery fistula, 1 from implantation superior vena cava filter,1 from mapping of NOGA and 1 from pericardiocentesis. 6 cases were diagnosed in the catheterization laboratory as early cardiac tamponade, another 6 who had a delayed presentation were diagnosd as delayed cardiac tamponade. The clinical presentions of early cardiac tamponade were a sudden drop in blood pressure and heart rate, and of delayed cardiac tamponade were sudden hypotension, bradycardia and shock .10 patients were retrieved,2 died. Conclusion:The key points of rescue include strengthening awareness of the possibility of cardiac tamponade ,early recognizing clinical presention , pericardiocentesis and necessary surgical intervention in time.