无对比剂外泄征象患者冠状动脉介入治疗后急性心包填塞的临床特点  

The clinical characteristics of acute pericardial tamponade in patients undergoing PCI without contrast medium extravasation

作　　者：史冬梅[1] 周玉杰[1] 刘思朦[1] 王志坚[1] 成万钧[1] 郭永和[1] 刘宇扬[1] 

机构地区：[1]首都医科大学附属北京安贞医院老年心内科,100029

出　　处：《中华老年心脑血管病杂志》2010年第12期1093-1094,共2页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的分析无对比剂外泄征象PCI术后急性心包填塞的临床特点。方法分析12例PCI术后出现急性心包填塞患者的临床表现及处理方法。结果 12例患者中,9例术中支架释放不能充分扩张,使用高压球囊扩张后;2例普通球囊扩张后;1例对吻扩张后,出现剧烈的胸痛,持续时间较长,不能缓解,术中造影未发现对比剂外渗的现象。12例患者术后6～8 h出现血压下降,心率加快,经超声心动图证实为急性心包填塞,行心包穿刺并留置猪尾导管持续引流,并再次行冠状动脉造影仍未发现对比剂外渗现象。1 2例患者经对症治疗痊愈出院。结论造影显示无对比剂外泄并不能完全除外心包填塞的可能。及时心包穿刺引流等对症治疗后,多数患者预后良好。Objective To analyze the clinical characteristics of acute perieardial tamponade in patients undergoing PCI without contrast medium extravasation. Methods Twelve cases of acute pericardial tamponade occurred in our department over past 9 years of PCI. The clinical data were collected and summarized retrospectively. Results Of 12 eases,9 used high pressure balloon due to stent malapposition, 2 used common balloon dilation and 1 used kissing balloon. Following these procedures, all cases developed serious chest pain without obvious alleviation, and no contrast medium extravasation was detected by angiography. In 12 patients,blood pressure decreased and heart rate quickened 6--8 hours after PCI. Paracentesis pericardii was performed and pigtail catheter was detained following confirmation of acute pericardial tamponade by ultrasonic cardiography. All patients recovered well with fluid replacement. Conclusion Onee pericardial tamponade is confirmed,paraeentesis pericardii and catheter detainment should be applied as soon as possible combined with discontinuation of anticoagulation therapy and fluid replacement. After these treat- ments,patients usually had a good prognosis.

关 键 词：心脏压塞 血管成形术 经腔 经皮冠状动脉 手术后并发症 气囊扩张术 心包穿刺术 冠状血管造影术 

分 类 号：R542.1[医药卫生—心血管疾病]