心脏直视手术围术期穿刺导致腹部大出血八例报告  

Intra-abdominal Hematorrhea Caused by Perioperative Paracentesis During Open Heart Surgery

作　　者：刘迎龙[1] 潘世伟[1] 孙立忠[1] 萧明第[1] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所心外科,中国医学科学院中国协和医科大学阜外心血管病医院心外科

出　　处：《中国循环杂志》1996年第2期82-84,共3页Chinese Circulation Journal

摘　　要：目的：本文总结了心脏直视手术围术期穿刺导致腹部大出血的教训。方法：１９７７年至１９９２年共８例因心脏直视手术围术期穿刺导致腹部大出血，其中复杂小儿心脏畸形矫治术６例，室间隔缺损并肺动脉高压１例，冠状动脉旁路移植术１例。６例因胸腔穿刺损伤肝脏出血，２例因股动脉穿刺或大隐静脉切开置入的插管头损伤髂动脉及髂静脉而引起腹部出血。７例剖腹止血，１例尸检证实。穿刺至手术时间为２４．６±１９．８（３～５６）小时。结果：４例死亡（５０％），其中多脏器衰竭２例，灌注肺合并感染１例，出血性休克１例。结论：本症与操作技术不当、小儿胸壁较薄、复杂先天性心脏病矫治术后肝大或肝位置异常有关，一经确诊后，应尽早手术。Objective : This study was conducted to sum up the lessons of intra-abdominal hematorrhea caused by perioperative paracentesis during open heart surgery. Methods: From 1977 to 1992, 8 patients, 6 complex cardiac anomalies, 1 VSD with PH and 1 coronary artery disease,had abdominal hematorrhea due to perioperative accidental injury including 6 of hepatic injury during thoracic paracentesis,1 each of iliac artery injury due to paracentesis at the femoral artery and iliac vein injury caused by tip of the tube during saphenous vein intubation. The diagnoses were demonstrated by abdominal exploratory operation in 7 cases and autopsy in 1. The mean time from paracentesis to abdominal exploratory operation was 24.6±19. 8 (3-56 ) hours. Results: Four of the patients died (50% ), 2 of multiorgan failure,1 of ARDS with infection and 1 of hemorrhagic shock. Conclusion:This complication was related to improper paracentesis,thin chest wall of pediatric patients, postoperative hepatomegaly and abnomal position of liver in patient s with complex cardiac anomalies. Once the diagnosis is established, abdominal exploratory operation should be performed as early as possible.

关 键 词：心脏直视手术 腹部 出血 穿刺 

分 类 号：R654.205[医药卫生—外科学] R442.7[医药卫生—临床医学]