经皮冠脉介入治疗Ⅲ型冠脉穿孔合并心包填塞15例临床分析  

Clinical Analysis of 15 Cases of Type Ⅲ Coronary Artery Perforation Combined with Pericardial Tamponade by Percutaneous Coronary Intervention

作　　者：卓辉林[1] 张克连[1] 戴若竹[1] ZHUO Huilin;ZHANG Kelian;DAI Ruozhu(Department of Cardiology,Quanzhou First Hospital,Fujian Medical University,Quanzhou,Fujian Province,362000 China)

机构地区：[1]福建医科大学附属泉州第一医院心内科,福建泉州362000

出　　处：《中外医疗》2021年第13期58-61,共4页China & Foreign Medical Treatment

摘　　要：目的总结该院15例经皮冠脉介入治疗Ⅲ型冠脉穿孔合并心包填塞的临床特点。方法回顾性分析2012年1月—2020年1月该院收治的15例经皮冠脉介入治疗中Ⅲ型冠脉穿孔合并心包填塞患者临床资料,均表现烦躁不安、心率快、血压下降及颈静脉充盈,冠脉造影证实冠脉穿孔,X线透视下或者心脏彩超证实心包积液,有效的治疗手段为立即床边心包穿刺引流,血管活性药升压、静脉补液扩容并立即有效处理冠脉穿孔,记录患者年龄、诊断、性别、病变分型、穿孔的原因、穿孔的血管及部位、心包填塞发生时间、处理措施、术中及围手术期预后。结果患者平均年龄为(67±15)岁,男性比例86.7%,不稳定型心绞痛86.7%,AHA/ACC冠脉病变分型C型病变77.3%,77.3%穿孔发生于LAD,13.3%发生于LCX,另外13.3%发生于RCA,77.3%穿孔原因为非顺应性球囊高压后扩张,20.0%穿孔原因为PCI导丝穿孔,66.7%穿孔需覆膜支架封堵冠脉破口,20.0%穿孔成功通过扩张球囊压迫封堵穿孔,20.0%穿孔成功通过栓塞治疗封堵穿孔,13.3%患者覆膜支架急性血栓形成,20.0%患者术中死亡。结论经皮冠脉介入治疗Ⅲ型冠脉穿孔合并心包填塞,病死率高,贵在早认识、早发现,及时心包穿刺引流并积极有效处理冠脉穿孔是抢救成功的关键。Objective To summarize the clinical characteristics of 15 cases of percutaneous coronary intervention in the hospital for type Ⅲ coronary perforation combined with pericardial tamponade.Methods Retro spectiove analysis a total of 15 cases of type Ⅲ coronary perforation combined with pericardial tamponade in the hospital from January 2012 to January 2020 were admitted.All patients showed irritability,rapid heart rate,decreased blood pressure,jugular vein filling,and coronary artery.Coronary artery perforation is confirmed by angiography,pericardial effusion can be confirmed by X-ray fluoroscopy or heart color Doppler ultrasound.Effective treatments are immediate bedside pericardiocentesis and drainage,vasoactive drugs to increase pressure,intravenous fluid rehydration,and immediate effective treatment of coronary perforation,and record the patient’s age,diagnosis,gender,lesion type,cause of perforation,blood vessel and location of perforation,time of occurrence of pericardial tamponade,treatment measures,intraoperative and perioperative prognosis.Results The average age of the patients was(67±15)years old,the proportion of men was 86.7%,the unstable angina pectoris 86.7%,the AHA/ACC coronary artery lesion type C type lesions 77.3%,77.3%perforation occurred in LAD,13.3%occurred in LCX,and 13.3%occurred in RCA,77.3%of perforation was caused by non-compliant balloon hypertension and expansion,20.0%of perforation was caused by PCI guide wire perforation,66.7%of perforation required a stent graft to seal the coronary rupture,and 20.0%of perforation successfully passed the expansion Balloon compression blocked the perforation,20.0%of the perforations were successfully blocked by embolization,13.3%of patients with acute thrombosis of the covered stent,and 20.0%of patients died during the operation.Conclusion Percutaneous coronary intervention for type Ⅲ coronary artery perforation combined with pericardial tamponade has a high mortality rate.Early recognition and early detection are important.Timely pericardioce

关 键 词：冠脉介入治疗 Ⅲ型冠脉穿孔 心包填塞 

分 类 号：R4[医药卫生—临床医学]