心脏介入性治疗中并发急性心脏压塞的诊断与治疗体会

目的 总结心脏介入性治疗中发生急性心脏压塞诊断和处理的经验与教训。方法 回顾性分析1986年1月至2003年6月1442例心脏病介入手术导致急性心脏压塞的资料。结果 4例患者在介入治疗术中或术后即刻出现胸闷、烦躁、大汗淋漓、血压下降、心率加快或减慢，X线示心脏搏动减弱或超声心动图示心包积液，诊断为急性心脏压塞，发生率0．3％，其中1例发生在植入起搏器术后即刻，1例在二尖瓣球囊扩张行房间隔穿刺时，2例发生于射频导管消融过程中。3例经心包穿刺引流成功，1例因射频导管消融导致左心房穿孔，心包穿刺失败，未能及时开胸切开心包，患者死亡。结论 心脏病介入性治疗操作术中并发急性心脏压塞可危及生命，及时诊断与处理非常重要，心包穿刺引流是首选的方法，必要时应及时开胸切开心包减压。

Diagnosis and treatment of acute cardiac tamponade during cardiac intervention

Objective To summarize the experiences of diagnosis and management of the acute cardiac tamponade complicating cardiac interventional therapy.Methods The database of 1 442 cases with cardiac interventional therapy from Jan.1986 to Jun.2003 were analyzed.Results Four patients were diagnosed with acute cardiac tamponade according to the followings:chest depression,restlessness,dripping wet,blood pressure decrease,tachycardia or bradycardia,weak heart beat under fluoroscopy or pericardial effusion under echocardiography.The incidence was 0.3%.Of them,one case occurred immediately after pacemaker implantation,another occurred during puncturing atrial septum in percutaneous balloon mitral valvoplasty(PBMV)procedure,the others occurred during radiofrequency catheter ablation(RFCA).Pericardiocentesis were performed successfully in 3 cases.One case died of acute cardiac tamponade due to left atrial perforation during RFCA with pericardiocentesis and pericardial incision through thoracotomy unsuccessfully.Conclusions Acute cardiac tamponade is a serious complication in cardiac interventional procedures.It should be recognized early and treated early and correctly.Pericardiocentesis is the treatment of choice once acute cardiac tamponade was confirmed.It is necessary to undergo pericardial incision through thoracotomy immediately when pericardiocentesis was unsuccesful.