目的:探讨心导管检查术及心脏介入术中发生心脏穿孔、心脏压塞的原因及紧急处理的方式和效果。方法:回顾性分析1986年1月至2009年12月在中南大学湘雅二医院心导管室接受诊断性心导管检查术或各种心脏介入术共23319例患者的资料。结果:在23319例各种心导管术中,共有22例(0.094%)发生急性心脏压塞。其分布情况为:冠状动脉造影术1例,二尖瓣球囊扩张术9例,心导管检查术3例,先天性心脏病介入治疗2例,起搏器安置术2例,心房颤动射频消融术2例,冠心病介入治疗3例。11例与房间隔穿剌或经房间隔手术有关,2例与高压注射有关。17例发生在手术中,5例发生在术后2~14h。11例经心包穿刺引流抢救成功;11例经开胸减压并治疗原发心脏病,7例抢救成功,4例手术后仍然死亡。结论:心脏压塞是各种心导管术中的一种危及生命的严重并发症。提前防范、及早发现并做心包穿剌引流术是成功抢救病人的关键。
Objective To explore the cause of cardiac perforation and tamponade during cardiac catheterization and intervention and to evaluate the effectiveness of the emergency treatment for tamponade in our hospital.Methods The clinical data from 23 319 patients who received diagnostic catheterization or therapeutic procedures were analyzed retrospectively.Results Cardiac perforation and cardiac tamponade were observed in 22 of the 23 319 patients during catheter procedures.It includes 1 in coronary artery angiography,9 in percutaneous balloon mitral valvuloplasty,3 in diagnosis,2 in congenital heart disease intervention,2 in pacemaker implantation,2 in atrial fibrillation ablation and the other 3 in coronary revascularization.The occurrence of cardiac perforation in 11 patients was related to puncture of the interatrial septum and/or the procedure in the left atrial procedure and 2 were related to high pressure injection.Seventeen patients were found cardiac tamponade in the process of catheterization,and 5 were found at 2-14 h after operation.Pericardiocentesis and pericardial catheter drainage were performed in 20 patients and 11 of them succeeded.Among the other 11 patients,7 were successfully saved by thoracotomy and 4 died.Conclusion Cardiac tamponade is a severe and fatal complication that may occur in different catheter procedures.Early prevention and diagnosis and performingperi cardiocentesis and drainage timely are critical to reduce the mortality.