心脏介入性治疗并发心脏压塞的原因分析、诊断与治疗

目的总结心脏介入性治疗过程中发生心脏压塞诊断和处理的经验和教训。方法回顾分析快速性心律失常射频消融术、经皮冠状动脉腔内成形术(PTCA)及支架术以及先天性心脏病封堵术中心脏压塞的临床特点、诊断及处理。结果18例与心脏介入性诊治操作有关的心脏压塞患者,17例为急性心脏压塞,1例在术后72小时延迟出现。18例中9例与射频消融术有关;5例与PTCA有关;3例与先天性心脏病房间隔缺损修补术有关;1例与临时起搏器安装术有关。共有3例死亡。结论心脏介入性治疗可引起即刻和迟缓性两类心脏压塞,多与操作不当有关。及时诊断与处理非常重要,心包穿刺引流是首选方法,必要时应及时切开心包减压或开胸修补。

The Cause, Diagnosis and Management of Cardic Tamponade Complicating Cardiac Interventional Therapy

Objiective: To summarize the experiences of diagnosis and management of the cardiac tamponade complicating cardiac interventional therapy. Methods: The clinic characteristics of the cardiac tamponade were analyzed in patients undertaking cardiac radiofrequency catheter ablation, PTCA and interventional therapies for ASD. Results: Eighteen patients underwent interventional procedures had cardiac tampanade. Nine of the 18 patients were caused by radiofrequency catheter ablation, 5 by PTCA and 3 by transcatheter ASD closure. Three of the 18 patients died. Conclusion: Cardiac tamponde occurs instantly during and late after the interventional procedures for heart disease. It associated with difficulties in manipulating the catheter or guide-wire in the majority of cases. To reduce the complication incidence, caution must be taken in manipulating catheter or guide-wire while performing cardiac interventional procedures. It should be recognized early and treated early and correctly. Pericardiocentesis is the treatment of choice once cardiac tamponade was confirmed. It is necessary to undergo pericardial incision through thoracotomy immediately when pericardiocentesis was unsuccessful.