Taavitsainen M, Bondestam S, Mankinen P, Pitkäranta P, Tierala E
Department of Diagnostic Radiology, Meilahti Hospital, Helsinki, Finland.
Acta Radiol. 1991 Jan;32(1):9-11.
Sonographic guidance with 41 punctures and 38 catheterizations was employed in 68 patients. The approach was either intercostal or subxiphoid. Most punctures were performed with a 1.4-mm-thick plastic-sheathed cannula after local anesthesia. Complications were observed in 7 patients. In one patient a catheter introduced with a movable core-type guidewire pierced the right ventricle wall with uneventful recovery after surgery. Intercostal drainage caused pleural pain in 2 patients, and in 2, leakage to the pleural space. Two patients with heart transplants had severe bradycardia and drop of blood pressure, one after needle drainage and the other during guidewire manipulation. Direct monitoring generally ensures a correct position of the instruments and hazards to adjacent organs can be avoided. In small effusions a simple needle aspiration with a plastic-sheathed cannula is safer than catheter drainage.
68例患者采用超声引导进行了41次穿刺和38次置管。穿刺途径为肋间或剑突下。大多数穿刺在局部麻醉后使用1.4毫米厚的塑料鞘套管进行。7例患者出现并发症。1例患者使用可移动芯型导丝置入导管时刺破右心室壁，术后恢复顺利。肋间引流导致2例患者出现胸痛，2例患者出现胸腔渗漏。2例心脏移植患者出现严重心动过缓和血压下降，1例在穿刺引流后发生，另1例在导丝操作过程中发生。直接监测通常可确保器械位置正确，并可避免对邻近器官造成危害。对于少量胸腔积液，使用塑料鞘套管进行单纯穿刺抽吸比置管引流更安全。
