Traen Marijke, Schepens Elisabeth, Laroche Sabine, van Overmeire Bart
Department of Paediatrics, Division of Neonatology, Antwerp University Hospital, Edegem, Belgium.
Acta Paediatr. 2005 May;94(5):626-8. doi: 10.1111/j.1651-2227.2005.tb01950.x.
We present three cases of neonatal cardiac tamponade due to umbilical venous catheterization, a rare, but potentially fatal complication.
Timely diagnosis was made by echocardiography, and an urgent pericardiocentesis revealed TPN fluid. Perforation of the cardial wall was proven by contrast X-ray showing contrast diffusing into the pericardial space.
Most frequently, perforation has a delayed course and results from endothelial injury, caused by the hyperosmolar fluids, leading to transmural necrosis and thrombosis. Subsequently, the fluid diffuses transmurally across the myocardium into the pericardium. As migration of the catheter tip can occur, we suggest that its position should be checked immediately after insertion and twice a week thereafter.
Pericardial effusion and cardiac tamponade should be considered in any infant with a central venous line who develops a rapid, unexplained clinical deterioration. Timely diagnosis and drainage has been proven to be life-saving.
我们报告3例因脐静脉插管导致的新生儿心脏压塞病例，这是一种罕见但可能致命的并发症。
通过超声心动图及时做出诊断，紧急心包穿刺抽出了全胃肠外营养液（TPN）液体。心脏造影X线显示造影剂扩散到心包腔，证实了心肌壁穿孔。
大多数情况下，穿孔过程具有延迟性，是由高渗液体引起的内皮损伤导致透壁坏死和血栓形成所致。随后，液体经心肌透壁扩散至心包。由于导管尖端可能移位，我们建议在插管后立即检查其位置，之后每周检查两次。
对于任何置有中心静脉导管且出现快速、不明原因临床恶化的婴儿，均应考虑心包积液和心脏压塞。已证实及时诊断和引流可挽救生命。
