新生儿脐静脉置管相关心包积液3例  

Three cases of neonatal pericardial effusion related to umbilical venous catheterization

作　　者：杨璞[1] 汪霞[1] 郑君文[1] 刘玭[1] 冯淑文 魏聪[1] 何秉燕[1] 赵东赤[1,2] Yang Pu;Wang Xia;Zheng Junwen;Liu Pin;Feng Shuwen;Wei Cong;He Bingyan;Zhao Dongchi(Department of Pediatrics,Women and Children's Hospital,Zhongnan Hospital of Wuhan University,Wuhan 430071,China;Children's Digital Health and Data Center of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院妇儿医院儿科,武汉430071 [2]武汉大学儿童健康大数据研究中心,武汉430071

出　　处：《中华实用儿科临床杂志》2023年第3期226-229,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：湖北省卫生健康委员会科研项目(WJ2021M173)。

摘　　要：回顾性分析2020年12月至2022年4月武汉大学中南医院妇儿医院儿科新生儿重症监护室3例脐静脉置管后发生心包积液的新生儿的临床资料。3例均为早产儿,胎龄分别为33^(+4)周、31周和27^(+6)周,出生后24 h内行脐静脉置管,置管后第1-4天出现呼吸困难、血氧饱和度下降、心率异常、心音低钝遥远等表现,床旁超声提示心包积液,予心包穿刺引流,2例症状缓解且预后良好,1例死亡。新生儿脐静脉置管可于置管早期并发心包积液,置管后新生儿出现呼吸困难、发绀和心率异常等突然恶化的临床表现,应考虑心包积液及压塞可能,一旦确诊应及时拔出脐静脉导管,行心包穿刺抽液减压。早期诊断及干预可有效改善预后。A retrospective case review was conducted of 3 cases with umbilical venous catheterization(UVC)related pericardial effusions in the Neonatal Intensive Care Unit of Zhongnan Hospital of Wuhan University from December 2020 to April 2022.All 3 cases were preterm infants with gestational ages of 33^(+4),31 and 27^(+6) weeks,respectively.UVC was inserted routinely in 24 hours after birth.Three neonates developed tachycardia or bradycardia,dyspnea,decreased oxygen saturation and muffled heart sound at the 1^(st) to 4^(th) day after catheterization.Echocardiography indicated pericardial effusion,so the 3 neonates underwent pericardiocentesis and drainage.Among the 3 neonates,2 cases improved and have good prognosis,1 case died.UVC can cause pericardial effusion,which occurs mostly in the early stage after catheterization.Pericardial effusion and tamponade should be considered when patients show unexplained sudden clinical deterioration after catheterization,such as dyspnea,cyanosis,tachycardia or bradycardia,etc.Once diagnosed,umbilical vein catheter should be removed in time and pericardiocentesis and drainage should be performed for decompression.Early diagnosis and intervention can effectively improve the prognosis.

关 键 词：心包积液 心包压塞 脐静脉置管 中心静脉置管 新生儿 

分 类 号：R722.1[医药卫生—儿科]