Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA.
Am J Cardiol. 2011 Dec 15;108(12):1820-5. doi: 10.1016/j.amjcard.2011.07.057. Epub 2011 Sep 10.
Recurrence of pericardial tamponade is relatively common after pericardiocentesis. We evaluated the clinical and procedural predictors of recurrent pericardial tamponade after pericardiocentesis. We included 157 consecutive patients with pericardial tamponade (age 62 ± 18 years, 54% men) who had undergone pericardiocentesis from 2000 to 2007. An intrapericardial catheter was used for prolonged drainage of the pericardial effusion (78% of cases) at the discretion of the operator. The overall recurrence rate 11.8 ± 0.6 months after pericardiocentesis was 20% and the mean interval to recurrence was 1.2 ± 2.1 months. However, patients with extended catheter drainage had a reduced recurrence rate of 12% compared to 52% in patients without extended drainage (p <0.001). In the Cox regression modeling, absence of extended drainage (hazard ratio [HR] 4.1, 95% confidence interval [CI] 1.7 to 10, p = 0.002), incomplete drainage of pericardial effusion (HR 9.7, 95% CI 3.6 to 22.7, p <0.001), loculated effusion (HR 11.1, 95% CI 2.9 to 43, p = 0.001), and malignancy (HR 3.3, 95% CI 1.8 to 10.3, p = 0.037) independently correlated with recurrence at 1 year. In conclusion, extended pericardial drainage after catheter placement is associated with a reduced recurrence of pericardial tamponade after pericardiocentesis.
心包穿刺后心包填塞复发相对常见。我们评估了心包穿刺后心包填塞复发的临床和操作预测因素。我们纳入了 2000 年至 2007 年期间因心包填塞而行心包穿刺的 157 例连续患者（年龄 62 ± 18 岁，54%为男性）。根据操作者的判断，使用心包内导管对心包积液进行长时间引流（78%的病例）。心包穿刺后 11.8 ± 0.6 个月的总体复发率为 20%，平均复发间隔为 1.2 ± 2.1 个月。然而，与未行延长引流的患者（52%）相比，行延长引流的患者复发率较低（12%）（p <0.001）。在 Cox 回归模型中，无延长引流（危险比 [HR] 4.1，95%置信区间 [CI] 1.7 至 10，p = 0.002）、心包积液引流不完全（HR 9.7，95% CI 3.6 至 22.7，p <0.001）、局限性积液（HR 11.1，95% CI 2.9 至 43，p = 0.001）和恶性肿瘤（HR 3.3，95% CI 1.8 至 10.3，p = 0.037）与 1 年后的复发独立相关。总之，导管放置后延长心包引流与心包穿刺后心包填塞复发率降低相关。
