Curyło A M
I Kliniki Kardiologii Akademii Medycznej im. M. Kopernika, Krakowie.
Folia Med Cracov. 1991;32(1-2):33-41.
Fluid in the pericardial sac may accumulate due to transudate, inflammatory process in the pericardium, shunting of blood from the ventricles or large vessels into the pericardial cavity. The presence and amount of fluid is best evaluated by using echocardiography. Pathological fluid in the pericardial sac does not cause major hemodynamic disorders until the intrapericardial pressure is normal. This condition is treated mainly pharmacologically. An increase in the intrapericardial pressure and its equalization with the right and left ventricular diastolic pressure lead to cardiac tamponade which is characterized by decreased cardiac output and increased central venous pressure. Severe tamponade may result in cardiac arrest due to electromechanical dissociation. In lighter cases one can observe tachycardia, tachypnoe, fall in arterial blood pressure, rise in central venous pressure, paradoxical pulse. The patients complain of dyspnea and chest pain. Cardiac tamponade may be due to all causes of fluid accumulation in the pericardial sac, but most frequently it results from perforation or rupture of the left ventricle or aorta, and severe idiopathic, viral, uremic or neoplastic pericarditis. Therapy in cardiac tamponade consists of removal of the pericardial fluid by means of pericardiocentesis, pericardiotomy or pericardiectomy.
心包腔内的液体可能因漏出液、心包的炎症过程、血液从心室或大血管分流至心包腔而积聚。通过超声心动图可最佳地评估液体的存在及量。在心包内压力正常之前，心包腔内的病理性液体不会引起严重的血流动力学紊乱。这种情况主要通过药物治疗。心包内压力升高并与左右心室舒张压平衡会导致心脏压塞，其特征为心输出量减少和中心静脉压升高。严重的心脏压塞可能因电机械分离导致心脏骤停。在较轻的病例中，可观察到心动过速、呼吸急促、动脉血压下降、中心静脉压升高、奇脉。患者会诉说呼吸困难和胸痛。心脏压塞可能由心包腔内液体积聚的所有原因引起，但最常见的是左心室或主动脉穿孔或破裂，以及严重的特发性、病毒性、尿毒症性或肿瘤性心包炎。心脏压塞的治疗包括通过心包穿刺术、心包切开术或心包切除术清除心包积液。
