Renkin J, de Bruyne B, Benit E, Joris J M, Carlier M, Col J
Intensive Care Department, University of Louvain Medical School, Brussels, Belgium.
J Am Coll Cardiol. 1991 Jan;17(1):280-5. doi: 10.1016/0735-1097(91)90739-v.
Among 392 consecutive patients admitted for acute myocardial infarction and treated with thrombolytic drugs, 4 patients (1%) developed an early hemorrhagic pericardial effusion (without ventricular wall rupture) evolving within 24 h to cardiogenic shock consequent to cardiac tamponade. They all suffered from a large anterior myocardial infarction treated within 4 h after onset of symptoms with intravenous anisoylated plasminogen streptokinase activator complex (one case), recombinant tissue-type plasminogen activator (rt-PA) (two cases) or streptokinase (one case), anticoagulation with heparin (all cases) and aspirin (three cases). As soon as pericardial effusion was established by echocardiography, emergency percutaneous pericardiocentesis was performed at the bedside 20 +/- 6 h after thrombolytic therapy was started. This corrected immediately the clinical and hemodynamic status of each patient and a catheter was left in the pericardial space for 34 +/- 18 h. Thus, in the presence of unexplained clinical and hemodynamic deterioration occurring during the first 24 h after thrombolytic treatment of a large myocardial infarction, cardiac tamponade should be suspected. Immediate percutaneous pericardiocentesis followed by continuous drainage is a simple and definitive treatment for this complication.
在392例因急性心肌梗死入院并接受溶栓药物治疗的连续患者中，4例（1%）出现早期出血性心包积液（无室壁破裂），在24小时内进展为因心脏压塞导致的心源性休克。他们均患有大面积前壁心肌梗死，在症状发作后4小时内接受了静脉注射茴香酰化纤溶酶原链激酶激活剂复合物（1例）、重组组织型纤溶酶原激活剂（rt-PA）（2例）或链激酶（1例）治疗，均接受肝素（所有病例）和阿司匹林（3例）抗凝治疗。一旦通过超声心动图确诊心包积液，在开始溶栓治疗后20±6小时在床边进行紧急经皮心包穿刺术。这立即纠正了每位患者的临床和血流动力学状态，并在心包腔内留置导管34±18小时。因此，在大面积心肌梗死溶栓治疗后的最初24小时内出现无法解释的临床和血流动力学恶化时，应怀疑心脏压塞。立即进行经皮心包穿刺术并持续引流是治疗该并发症的简单而有效的方法。
