经皮直接冠状动脉介入治疗急性ST段抬高性心肌梗死术后迟发性心脏压塞  

Delayed occurrence of cardiac tamponade following percutaneous coronary intervention for ST-segment elevation myocardial infarction

作　　者：刘莉[1] 刘利峰[1] 彭佑华[1] 刘瑛琪[1] 赵京涛[1] 刘彦敏[1] 周莉[1] 夏会会 高铁山[1] 

机构地区：[1]解放军第306医院心内科,北京100101

出　　处：《中华急诊医学杂志》2015年第2期196-199,共4页Chinese Journal of Emergency Medicine

摘　　要：目的 总结直接经皮冠状动脉介入治疗术（PPCI）治疗急性ST段抬高性心肌梗死（STEMI）后迟发性心脏压塞的临床特点、早期诊断、早期处理和救治结果.方法 分析解放军第306医院自2011年8月至2014年3月共503例STEMI行PPCI后并发迟发性心脏压塞3例（0.6％）的临床表现及诊疗经过.结果 3例迟发性心脏压塞发生在STEMI后18 ～54 h内,PPCI术后14～46 h.梗死部位均为前壁,靶血管均为前降支.其中2例首发症状为血压突然降低,1例表现为与呼吸有关的胸痛,并可闻及心包摩擦音.3例均在床旁超声引导下经心包穿刺引流,并保留引流管2～3d,均痊愈出院.结论 PPCI治疗STEMI后迟发性心脏压塞最易发生在术后3d内,故需强化早期识别此类患者的临床表现,而急诊床旁心脏超声检查是快速诊断的关键,及时行心包穿刺引流,可改善预后.Objective To analysis the clinical characteristics,early diagnosis,management and outcome of patients with ST-segment elevation coronary infarction （STEMI） complicated by delayed cardiac tamponade after primary percutaneous cardiac intervention （PPCI）.Methods A cohort of consecutive 503 STEMI patients after PCI admitted between August 2011 and March 2014 were analyzed,and the diagnosis of cardiac tamponade was confirmed in 3 patients （0.6%）.Results Three cases of cardiac tamponade were found in the period of 18-54 h after STEMI and in the period of 14-46 h after PPCI.All of the cases were of anterior wall AMI resulted from left anterior descending （LAD） stenosis.The initial symptom of two cases was sudden fall of blood pressure,while the other one was chest pain experienced during breathing and audible pericardium friction sound.All of the three cases received pericardiocentesis and drainage under sonographic guidance with retention of drainage for 2-3 days,and all were healed after aforesaid treatments.Conclusions Cardiac tamponade usually occurs in 72 h after STEMI,and constant vigilance to the complication of PCI by strengthening the awareness of diagnosis,identifying the early clinical characteristics and rapid examinations with bedside sonography was the key in prompt diagnosis of cardiac tamponade.Timely pericardiocentesis and drainage could improve outcome.

关 键 词：急性ST段抬高性心肌梗死 直接经皮冠状动脉介入治疗 心脏破裂 心脏压塞 迟发性 

分 类 号：R542.22[医药卫生—心血管疾病]