介入性治疗中急性心脏压塞的早期识别和急诊处理

目的 对心脏介入性治疗过程中发生急性心脏压塞的病例进行回顾性分析，总结经验和教训，以便及时发现和处理这种严重的并发症。方法 报告介入性操作相关的急性心脏压塞18例，约占同期进行心脏介入性治疗病例的0．36％。其中，部分与学习曲线有关，但各种操作都可能导致心脏压塞。结果 本组病例中包括二尖瓣球囊扩张、射频消融、冠状动脉支架植入、植入型心律转复除颤器(ICD)植入、临时起搏器植入、动脉导管未闭的封堵术等，所以，介入性操作中需要高度警觉。虽然发生率不高，但有可能造成相当严重的后果。本组死亡1例，继发于支架植入术后急性心脏压塞导致的低血压，诱发血栓形成造成急性心肌梗死。抢救成功17例，未遗留严重并发症。重点报告1例肺动脉瓣扩张术致右心室流出道破裂和1例ICD植入时右心室壁损伤的病例。结论 在介入性治疗中，急性心脏压塞的早期识别和果断处理是成功救治病人的关键。

Early recognition and urgent management of acute cardiac tamponade in interventional procedures

Objective The acute cardiac tamponade during invasive cardiac procedures was reviewed.Methods The acute cardiac tamponade occurred on 18 cases during from January 1984 to March 2003,which presented 0.36% of all cardiac intervention procedures.Some were related to learning-curve,but any kind of cardiac intervention could probably lead to cardiac tamponade.Results The complications were seen in our series with the Inoue balloon technique for mitral commissurotomy,radiofrequency ablation,coronary stenting procedure,ICD implantation,temporary pacing lead implantation,Amplatzer PDA occluder implantation,great caution should be taken during the procedure.Although the event rate was very low,the consequence is still quite severe.One patient died,due to acute cardiac infarction related stent implantation,other 17 cases were saved,no severe complications left behind.One case of the Inoue balloon technique for pulmonary stenosis led to perforation of right ventricular outflow tract and another case of the broken free wall of right ventricle during ICD implantation.conclusion During the procedure of cardiac intervention,early recognition and urgent treatment of acute cardiac tamponade are the key to save the patients.