进行心包穿刺和引流的心包积液患者的临床特点分析  

Analysis of Clinical Characteristics of Patients With Pericardial Effusion Undergoing Pericardiocentesis and Drainage

作　　者：曾艳[1] 马文菲[1] 陈少华[1] 兰玲[1] 刘佳妮[1] 王万荣[1] 刘启功[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院,武汉430030

出　　处：《内科急危重症杂志》2011年第5期276-278,共3页Journal of Critical Care In Internal Medicine

摘　　要：目的:探讨需要进行心包穿刺和引流的心包积液患者的临床特征,以指导该类患者的诊断和治疗。方法:总结并分析202例需要进行心包穿刺和引流的心包积液患者的临床特征、病因及心包积液性质。结果:除11例急性心肌梗死患者来不及进行心包穿刺外,191例均成功进行心包穿刺和引流,漏出液12例,渗出液179例。渗出液中,肿瘤性77例,结核性62例,医源性18例,急性心肌梗死15例,结缔组织疾病10例。77例肿瘤性心包积液中,肺癌42例,乳腺癌7例,原发灶暂时不明确的转移性腺癌6例,淋巴瘤7例,肝癌4例,纵隔瘤3例,胃癌、膀胱癌、直肠癌、心包肉瘤、横纹肌肉瘤、黑色素瘤、恶性胸腺瘤和心脏血管瘤各1例。18例医源性心包积液中,心律失常导管消融者10例,经皮冠状动脉介入治疗者6例。心律失常导管消融并发医源性心包积液的比例女性高于男性、房颤患者高于非房颤患者。9例导管消融者行心包穿刺和引流即可,余9例医源性心包积液还需外科修补。15例急性心肌梗死者在住院期间均死亡。结论:需要进行心包穿刺和引流的心包积液多为渗出液及血性,肿瘤和结核为主要原因,注意识别和鉴别医源性心包积液和急性心肌梗死,积极心包穿刺和引流是重要的治疗手段。Objective： To investigate the clinical characteristics of patients with pericardial effusion requiring pericardiocentesis and drainage in order to guide the diagnosis and treatments. Methods： Clinical characteristics and etiology of 202 cases with pericardial effusion requiring pericardiocentesis were analyzed. Results： Except 11 cases with acute myocardial infarction, pericardiocentesis and drainage were successfully performed in 191 cases, of which 12 cases with transudates and 179 cases with exudates. Among cases with exudates, 77 cases were neoplastic, 62 were tuberculous, 18 were iatrogenic, 15 with acute myocardial infarction and 10 with connective tissue diseases. Among 77 cases with malignant pericardial effusion, 42 were lung cancer, 7 were breast cancer, 6 were metastatic adenocarcinoma with unidentified primary foci, 7 were lymphoma, 4 were hepatocellular carcinoma, 3 were tumors of mediastinum, and each one for carcinoma of stomach, urinary bladder, rectum, pericardial sarcoma, leiomyosarcoma, melanoma, malignant thymoma and cardiac angioma. Among 18 cases with iatrogenic pericardial effusion, 10 cases undergoing catheter ablation for tachycardia, 6 cases undergoing percutaneous coronary intervention. The radio of developing iatrogenic pericardial effusion complicated by catheter ablation for tachycardia was higher in female than that of male and in patients with atrial fibrillation than that of non-atrial fibrillation. Pericardiocentesis and drainage was effective in 9 patients underwent catheter ablation, and the remaining 9 patients underwent surgical intervention after pericardiocentesis and drainage. All 15 patients with acute myocardial infarction died during hospitalization. Conclusions： Most of pericardial effusion requiring pericardiocentesis and drainage are exudates and bloody, which are mainly caused by malignancy and tuberculosis. Iatrogenic pericardial effusion should be carefully distinguished and differentiated from acute myocardial infarction, and pericardiocentesis and draina

关 键 词：肿瘤性心包积液 结核性心包积液 医源性心包积液 心包穿刺 急性心肌梗死 

分 类 号：R542.12[医药卫生—心血管疾病]