经皮冠状动脉介入治疗并发心包积液及心脏压塞的临床分析

目的 了解经皮冠状动脉介入治疗(PCI)中心包积液／心脏压塞发生率、发生的相关因素、处理以及预后，为PCI的正确操作及合理选用器械提供参考。方法 分析了1246例PCI资料，包括住院病历、PCI操作记录、护理记录和影像学资料，判定心包积液／心脏压塞发生原因、时间、临床表现、处理方式和结果。结果 共8例心包积液(0．64％)、3例心脏压塞(0．24％)，其中10例(91％)在导管室确诊，1例(9％)延期发现。冠状动脉造影直接发现导引钢丝和／或球囊致冠状动脉穿孔9例(81．8％)，其中球囊通过冠状动脉破口未扩张2例，球囊通过冠状动脉破口并扩张1例，冠状动脉穿孔多发生在慢性完全闭塞性病变(CTO)；通过临床表现、超声心动图证实起搏电极导线致右心室穿孔2例(18．2％)，均出现在心肌梗死后患者。球囊通过冠状动脉破口并扩张1例，发生迟发性心脏压塞，6h后急诊外科干预引流后治愈；右心室临时起搏电极导管穿破右心室2例，1例行心包穿刺术，另1例心包穿刺后留置猪尾导管引流2d成功治愈。结论 冠状动脉及右心室穿孔是PCI并发心包积液／心脏压塞的主要原因，前者多发生在CTO患者，后者易出现于心肌梗死后患者。正确的操作方法及合理的器械选择可能减少此并发症的发生。冠状动脉穿孔较心室穿孔易于诊断，心包积液／心脏压塞多数能在导管室早期发现，并能得以合理的处理。

Clinical analysis of pericardial effusion and cardiac tamponade complicating percutaneous coronary intervention

Objective The purpose of this study was to characterize the incidence, relative factors, management and clinical outcome of pericardial effusion and cardiac tamponade associated with percutaneous coronary intervention (PCI). Methods A successive database of 1 246 PCI, including medical, operation, and nursing record were analyzed to determine etiological factors, diagnosis time, clinical situation, management method and outcome of pericardial effusion and cardiac tamponade. Results There were 8 patients (0 64%) with pericardial effusion and 3 patients (0 24%) with cardiac tamponade in 1 246 PCI procedures. Ten patients (91%) were diagnosed in catheterization laboratory and 1 patient (9%) was diagnosed late. There were 9 cases of coronary perforation (81 8%) caused by guide wire or balloon by coronary artery angiography in patients with chronic total occulsion (CTO), including balloon across coronary artery without dilatation in 2 patients, with dilatation in 1 patient. Two cases of right ventricular perforation (18 2%) caused by pacing leads were determinated by echocardiogram and clinical manifestation in myocardial infarction patients. Pericardiocentesis was performed in 3 cases of cardiac tamponade. Conclusion Coronary and right ventricular perforation are main causes of pericardial effusion/cardiac temponade in PCI. Most pericardial effusion cases were observed in CTO patients, but more cardiac tamponade in MI patients. Correct technique and reasonable devices might reduce the incidence. The diagnosis of coronary perforation is easier than that of right ventricular perforation. Most coronary perforation can be diagnosed early in catheterization laboratory and can be treated reasonablely.