新生儿深静脉置管并发心包积液的病例报道及文献回顾  

Central venous catheter and umbilical venous catheter related pericardial effusion in neonate-five cases report and literature review

作　　者：朱东喆[1] 胡晓明[1] 李莉[1] 郑春华[2] 王碧玉[3] ZHU Dongzhe;HU Xiaoming;LI Li;ZHENG Chunhua;WANG Biyu(Department of Newborn Medicine,The Children's Hospital Affiliated to The Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院新生儿内科,北京100020 [2]首都儿科研究所附属儿童医院心血管内科,北京100020 [3]首都儿科研究所附属儿童医院呼吸内科,北京100020

出　　处：《空军医学杂志》2020年第2期141-144,共4页Medical Journal of Air Force

摘　　要：目的为了降低新生儿深静脉(脐静脉置管及中心静脉)置管并发心包积液的风险,对4例行脐静脉置管(umbilical vein catheter,UCV)及1例中心静脉置管(central venous catheter,CVC)置管后出现心包积液新生儿病例进行分析,从而为同行提供借鉴。方法回顾分析首都儿科研究所附属儿童医院新生儿科4例新生儿脐静脉置管及1例中心静脉置管并发心包积液的临床资料,并复习相关文献。结果 4例脐静脉置管均为早产儿,生后第1天按常规方法脐静脉置管,3例置管后第2天、第3天和第4天出现心率增快或下降、呼吸困难、血氧饱和度降低表现,超声心动图提示心包积液。1例患儿脐静脉置管后第6天常规行超声心动图监测提示心包积液。1例患儿为足月儿,阑尾炎切除术中行右颈CVC,置管后第9天出现心率增快,呼吸困难、血氧饱和度降低表现,床旁超声提示心包、胸腔及腹腔积液。分析原因可能是置管末端位置过深及输注高渗液体引起心脏并发症。予5例患儿拔除脐静脉置管及中心静脉置管,经抗感染、呼吸支持、维持循环稳定等处理,患儿症状均缓解,积液均消失。拔除UVC或CVC后5例患儿均行PICC置管,使用过程顺利,未出现相关并发症。结论新生儿深静脉置管可致心包积液,临床上对置管后突然出现心率变化、呼吸困难等表现应除外并发心包积液。此类患儿一旦确诊应立即拔除静脉置管,予抗感染及对症等治疗,预后良好。Objective To describe the clinical presentation, cause, and outcome of central venous catheter(CVC) and umbilical venous catheter(UVC)related pericardial effusions and in infants, provide experience for other physicians. Methods A retrospective case review was conducted of four UVC related pericardial effusions cases and one CVC related pericardial effusions case at the Children’s Hospital affiliated to the Capital Institute of Pediatrics, and the related literature was reviewed. Results Four umbilical venous catheter cases were premature infants. The venous catheter catheterization was performed routinely on the first day oflife. Three cases developed increased or decreased heart rate, dyspnea and decreased oxygen saturation on the second, third and fourth day after catheterization respectively. Echocardiography indicated pericardial effusion. Routine echocardiographic monitoring showed pericardial effusion in one case on the 6 th day after umbilical venous catheterization. One term infant underwent CVC during appendectomy. On the ninth day after catheterization, he developed increased heart rate, dyspnea and oxygen saturation decreased. Bedside ultrasound indicated pericardial, pleural and peritoneal effusion. The reason of pericardial effusions in the five cases may be due to the cardiac complications caused by the deep position of the catheter and the infusion of hypertonic fluid. The UVC and CVC were immediately removed when pericardial effusions was found. After anti-infection, respiratory support and maintenance of hemodynamics, the symptoms of the infants were relieved and the pericardial effusions disappeared. PICC was performed in all five cases, and was used smoothly without any complications. Conclusion UVC and CVC can cause pericardial effusion in neonate. When patients show unexplained sudden change of heart rate and dyspnea after catheterization, pericardial effusion should be considered. Once the diagnosis is confirmed, the catheter should be removed immediately and the prognosis could be good w

关 键 词：脐静脉置管 中心静脉置管 新生儿 心包积液 

分 类 号：R722[医药卫生—儿科]