塞尔丁格法心包穿刺置管引流术治疗急诊大量心包积液临床分析  

Clinical analysis of emergency pericardiocentesis with Seldinger puncture and tube drainage technique for pericardial effusion

作　　者：吴海东[1,2] 陈雪梅[1,2] 黄勇 吴满辉[1,2] 林小鸿[1,2] 黄子通[1,2] 

机构地区：[1]中山大学孙逸仙纪念医院急诊科 [2]中山大学心肺脑复苏研究所,广州510120 [3]南海狮山华立医院,南海528000

出　　处：《广州医药》2014年第5期26-28,共3页Guangzhou Medical Journal

基　　金：广东省科技计划社会发展项目(2012B031800084)

摘　　要：目的：探讨急诊塞尔丁格（Seldinger）法心包穿刺置管术的疗效及安全性。方法急诊大量心包积液合并有填塞症状的患者23例，按急诊来诊顺序分为常规穿刺组10例、塞尔丁格法组13例，塞尔丁格法组采用塞尔丁格法心包穿刺置管引流术，常规穿刺组采用传统的心包穿刺抽液术治疗，比较两组患者治疗前后症状变化，治疗后超声下心包内积液厚度变化情况，以及手术并发症。结果塞尔丁格法组患者均只行1次穿刺引流术，引流液总量约800～1500ml；常规穿刺组行2～3次穿刺抽液，抽液总量约700～1200ml。塞尔丁格法组患者症状缓解较明显。但两组患者引流术后的生理参数（心率、脉压差、呼吸频率和血氧饱和度）变化无统计学意义。治疗后复查超声示塞尔丁格法组心包内残留液体量少于常规穿刺组（P ＜0.05）。常规穿刺组术中出现室性早搏3例，塞尔丁格法组未见手术并发症。结论采用塞尔丁格法穿刺置管引流术可有效彻底引流心包内积液，安全性好，值得临床推广应用。Objective To investigative the effectiveness and safety of emergency pericardiocentesis with Seldinger puncture and tube drainage technique for pericardial effusion. Methods 23 emergency patients with large amount of pericardi-al effusion and tamponade symptom were included.In Seldinger＇s group,1 3 patients were performed with emergency pericardio-centesis with Seldinger puncture and tube drainage technique.In traditional pericardiocentesis （traditional）group,1 0 patients were performed with traditional pericardiocentesis drainage technique.The symptoms of patients,variation in thickness of pericar-dial effusion by ultrasound and complication were compared between the two groups. Results In Seldinger＇s group,patients were performed with puncture only one time,the gross drainage liquid were about 800 ~1 500ml.In the traditional group,pa-tients were performed with puncture 2 ~3 times,the gross infusion were about 700 ~1 200ml.The tamponed symptom were allevi-ated in the two groups.The changes of physiological parameter （heart rate,pulse pressure difference,respiratory rate,oxyhemo-globin saturation）after operations between the two groups had no statistical difference （P 〉0.05）.The residual liquid checked by ultrasound in the Seldinger＇s group were less than the traditional group （P 〈0.05）.The Seldinger＇s group had less complica-tion too. Conclusion Pericardiocentesis with Seldinger puncture and tube drainage technique for pericardial effusion can thor-ough drain liquid,it is worthy of clinical popularization and application for the effect and safety.

关 键 词：心包积液 心包穿刺 塞尔丁格法 

分 类 号：R542.12[医药卫生—心血管疾病]