Ristić Arsen D, Simeunovi Dejan, Milinković Ivan, Seferović-Mitrović Jelena, Maksimović Ruzica, Seferović Petar M, Maisch Bernhard
Department of Cardiology, Clinical Centre of Serbia, Belgrade University School of Medicine.
Acta Chir Iugosl. 2011;58(2):45-53. doi: 10.2298/aci1102045r.
Hemodynamic instability is the major concern in surgical patients with pericardial diseases, since general anesthesia and positive pressure ventilation may precipitate cardiac tamponade. In advanced constriction diastolic impairment and myocardial fibrosis/atrophy may cause low cardiac output during and after surgery. Elective surgery should be postponed in unstable patients with pericardial comorbidities. Pericardial effusion should be drained percutaneously (in local anesthesia) and pericardiectomy performed for constrictive pericarditis before any major surgical procedure. In emergencies, volume expansion, catecholamines, and anesthetics keeping cardiac output and systemic resistance should be applied. Etiology of pericardial diseases is an important issue is the preoperative management. Patients with neoplastic pericardial involvement have generally poor prognosis and any elective surgical procedure should be avoided. For patients with acute viral or bacterial infection or exacerbated metabolic, uremic, or autoimmune diseases causing significant pericardial effusion, surgery should be postponed until the causative disorder is stabilized and signs of pericarditis have resolved.
血流动力学不稳定是患有心包疾病的外科手术患者的主要担忧，因为全身麻醉和正压通气可能会诱发心脏压塞。在晚期缩窄性舒张功能障碍和心肌纤维化/萎缩可能导致手术期间及术后的心输出量降低。对于患有心包合并症的不稳定患者，择期手术应推迟。在任何重大外科手术前，应在局部麻醉下经皮引流心包积液，并对缩窄性心包炎进行心包切除术。在紧急情况下，应进行扩容、使用儿茶酚胺以及应用能维持心输出量和全身阻力的麻醉剂。心包疾病的病因是术前管理中的一个重要问题。患有肿瘤性心包受累的患者通常预后较差，应避免任何择期外科手术。对于患有急性病毒或细菌感染或代谢、尿毒症或自身免疫性疾病加重导致大量心包积液的患者，手术应推迟至病因性疾病稳定且心包炎体征消失。
