新生儿脐静脉置管并发急性心包压塞4例报告  

Neonatal umbilical vein catheterization complicated with pericardial tamponade:A report of four cases

作　　者：王淑荣[1] 张巍[1] 黄文卿[1] 李娜[1] 张亚南 WANG Shurong;ZHANG Wei;HUANG Wenqing;LI Na;ZHANG Yanan(Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing Meternal and Child Health Care Hospital,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院/北京妇幼保健院,北京100026

出　　处：《中国优生与遗传杂志》2023年第9期1894-1898,共5页Chinese Journal of Birth Health & Heredity

摘　　要：目的 分析脐静脉置管(UVC)相关急性心包压塞的临床特点,探讨其可能原因及预防。方法 回顾性总结近5年首都医科大学附属北京妇产医院4例脐静脉置管后心包压塞病例的临床特点、治疗和转归情况;结合文献复习,总结新生儿心包压塞的可能起因、临床特点、识别方法、治疗技术及防范措施,提出心包压塞的防治要点。结果 共纳入4例患儿,女1例,男3例,胎龄27~37周,出生体质量915~1950 g,生后1~5 h行脐静脉置管术,术后行X线定位导管顶端位置在T4~T6椎体水平,根据定位情况调整UVC位置后使用。患儿于置管后12~104h出现心率、血氧下降、心音低钝、遥远等心包压塞症状,给予心肺复苏、心包穿刺术后病情好转,拔除脐静脉置管后心包积液消失。心包压塞是脐静脉置管后的罕见且严重的并发症;UVC患儿出现血氧下降、心率改变(增快及下降)及心音低钝、遥远等症状需警惕心包压塞发生,导管位置偏移是其主要原因,放置UVC及时定位及定期X线或超声确认顶端位置非常必要;即刻床旁超声心动检查有助于心包压塞的快速诊断,及时心包穿刺抽液是挽救生命的关键。结论 心包压塞常导致休克及猝死。一旦使用UVC新生儿突然发生病情变化,迅速进行心包压塞排查,确诊后果断进行心包穿刺,病情大多可以缓解。Objective To analyze the clinical features of acute pericardial tamponade associated with umbilical vein catheterization(UVC)and explore its possible causes and prevention.Methods 4 cases of pericardial tamponade after umbilical vein catheterization in Beijing Obstetrics and Gynecology Hospital,Capital Medical University in recent 5 years were retrospectively summarized.Combined with literature review,the possible causes,clinical features,identification methods,treatment techniques and preventive measures of pericardial tamponade in neonates were summarized,and the key points of prevention and treatment of pericardial tamponade were put forward.Results A total of 4 children were enrolled,1 female,3 male,gestational age 27-37 weeks,birth weight 915-1950 g.Umbilical vein catheterization was performed 1-5 hours after birth.After operation,X-ray was performed to locate the tip of the catheter at the level of T4-T6 vertebral body,and UVC was used after adjusting the position according to the positioning situation.The symptoms of pericardial tamponade,such as decreased heart rate,decreased blood oxygen,dull heart sound and distant heart sound,appeared 12-104 hours after catheterization.After cardiopulmonary resuscitation and pericardiocentesis,the condition improved,and pericardial effusion disappeared after removal of umbilical vein catheterization.Pericardial tamponade is a rare and serious complication after umbilical vein catheterization.Children with UVC should be alert to the occurrence of pericardial tamponade when they have symptoms such as decreased blood oxygen,heart rate change(increase and decrease),low dull and distant heart sounds.The deviation of catheter position is the main reason.It is very necessary to confirm the top position of UvC by regular X-ray or ultrasound examination.Bedside echocardiography is helpful for rapid diagnosis of pericardial tamponade,and timely pericardial aspiration is the key to save lives.Conclusion Pericardial tamponade often leads to shock and sudden death.Once the conditio

关 键 词：脐静脉置管 心包压塞 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科]