急性心肌梗死介入术后早期心脏压塞四例并文献复习  

Early cardiac tamponade of acute myocardial infarction after percutaneous coronary intervention：case re-ports and literature review

作　　者：冯斯婷[1] 曾玉杰[1] 覃秀川[1] 吴溪[1] 

机构地区：[1]医科大学附属北京安贞医院急诊抢救中心,北京100029

出　　处：《中国医药》2013年第11期1533-1535,共3页China Medicine

基　　金：首都医学发展科研基金获准资助项目（2009-3022）

摘　　要：目的尽早发现急性心肌梗死介入术后早期心脏压塞的征象并及时处理，以避免猝死的发生。方法回顾性分析2010年1月至2012年6月北京安贞医院急诊抢救中心收治的急性心肌梗死行经皮冠状动脉介入术后发生心脏压塞的4例患者临床资料。结果严重心脏压塞患者收缩压下降20-30mmHg（1mmHg=0．133kPa），心率增加10—20次／min，超声心动图示术后2—12h内新出现右心房液深3—5mm，并舒张期右心房或右心室塌陷。结论急性心肌梗死介入术后排除其他导致低血压的原因并存在以上临床和心脏超声的证据时，应立即停止抗凝药物，尽早行心包穿刺或开窗引流术。Objective To early detect and promptly manage cardiac tamponade in acute myocardial infarc- tion patients underwent intervention management; therefore to avoid the incidence of sudden death. Methods The retrospective case analysis was performed in 4 clinical cases. Results The patients with severe cardiac tamponade showed systolic pressure decreased 20-30 mm Hg（ 1 mm Hg = 0. 133 kPa） heart rate increased 10-20 beats/min; ul- trasonic cardiogram in 2-12 hours indicated emerging 3-5 mm deep of effusion around right atrium and diastole col- lapse in right atrium or right ventricle. Conclusion After excluding the other reasons of hypotension, the patients undergoing intervention management with evidence of clinical and ultrasonic cardiogram should suspend anticoagula- tion and nromnflv nerform Dericardiocentesis and fenestration oericardium.

关 键 词：心肌梗死 心脏压塞 血管成形术 气囊 冠状动脉 

分 类 号：R541[医药卫生—心血管疾病]