改良中心静脉导管留置治疗心包积液80例临床评价

目的探讨改良中心静脉导管对中、大量心包积液进行心包穿刺置管引流的方法以寻求一种安全、有效、经济的治疗措施。方法患者取半卧位，超声心动图定位穿刺点。53例患者经剑突下进针，27例患者经左侧胸壁进针。采用Sendinger’s法，将改良中心静脉导管送入心包腔内，连接无菌引流袋引流积液。结果80例患者心包穿刺均获成功，未出现并发症。引流导管留置时间3～17d，平均14d。引流积液量700～2600ml（平均1228ml）。穿刺引流后患者胸闷、气短明显改善，休克征象消失，心率减低，心功能亦获明显改善。结论改良中心静脉导管心包积液穿刺置管引流术安全，可避免损伤心肌，留置导管可使引流彻底，避免堵塞，疗效可靠。

Clinical evaluation of percutaneous pericardial catheter drainage through a indwelling modified central venous catheter in the treatment of pericardial effusion : analysis of 80 eases

Objective To investigate pericardiocentesis through a modified central venous catheter for moderate to large pericardial effusion,and to discover a safe,effective and economic method for the treatment of pericardial effusion. Methods The patient was in a semi-reclining position. The insertion site was localized by echocardiography. Inserted the needle through the subxiphoid approach in 53 patients, and through left chest wall in 27 patients. Pericardial puncture was performed by using Seldinger s method. Central venous catheter introduced into the pericardial cavity,then connected catheter to sterile drainage bag and pericardial effusion was drained. Results All pericardial punctures were successful and had no complications. The catheters were indwelled for 3 days to 17 days, and for 14 days on average. The volume of drainage fluid was 700ml to 2600ml(1228ml on average). After drainage chest distress and short breath were remitted in all patients, signs of shock disappeared, heart rate decreased and heart function were significantly improved. Conclusions Pericardiocentesis through a indwelling modified central venous catheter is a safe and effective method for the treatment of pericardial effusion. It can avoid myocardial damage and prevent catheter blockage and drain completely.