Haponiuk Ireneusz, Kwasniak Ewelina, Chojnicki Maciej, Jaworski Radoslaw, Steffens Mariusz, Sendrowska Aneta, Gierat-Haponiuk Katarzyna, Leszczyńska Katarzyna, Paczkowski Konrad, Zielinski Jacek
Department of Pediatric Cardiac Surgery, Mikolaj Kopernik Hospital, Gdansk, Poland ; Chair of Physiotherapy, Gdansk Academy of Physical Education and Sport, Gdansk, Poland.
Department of Pediatric Cardiac Surgery, Mikolaj Kopernik Hospital, Gdansk, Poland.
Wideochir Inne Tech Maloinwazyjne. 2015 Apr;10(1):107-14. doi: 10.5114/wiitm.2014.47690. Epub 2015 Jan 14.
Cardiac tamponade is excessive collection of fluid in the pericardial sac surrounding the heart that leads to restriction of cardiac function and causes critical cardiogenic shock and rapid circulatory depression. Despite the potential variety of different etiologies in the face of a dangerous decrease of cardiac output, the emergency life-saving procedure is surgical pericardial fluid evacuation.
To perform a retrospective analysis of clinical data and the results of minimally invasive transxiphoid pediatric cardiac tamponade evacuation procedures performed in a cardiac surgery center.
We performed a retrospective analysis of all consecutive patients referred for treatment in our department in a period of 6 years (15 patients) who underwent emergency pericardial drainage after an echocardiographically proven diagnosis. The procedure of choice was minimally invasive transxiphoid fluid evacuation with routine pericardial drainage. Retrospective operative data analysis was performed: clinical symptoms, pre-admission and initial emergency diagnostics and interventions, the morphology and total amount of drained pericardial fluid, length of stay, final results, and overall survival rate. We introduced an original pediatric tamponade index (PTI). The PTI was analyzed according to catecholamine support before the drainage and the length of hospital stay after the procedure.
All patients survived the procedure. No early complications of the presented minimally invasive subxiphoid approach were noted. Mean PTI in patients with intensive catecholamine support before the operation was significantly higher than in patients without it.
Minimally invasive surgical transxiphoid interventions appear to be a safe and effective method to provide life-saving support with retrieval of the fluid for further laboratory investigations.
心脏压塞是指心脏周围心包腔内液体过度积聚，导致心脏功能受限，引发严重的心源性休克和快速循环衰竭。尽管面对心输出量危险下降时病因可能多种多样，但紧急救生程序是外科心包穿刺引流。
对心脏外科中心进行的小儿微创剑突下心包穿刺引流治疗心脏压塞的临床资料和结果进行回顾性分析。
我们对6年内转诊至我科接受治疗的所有连续患者（15例）进行回顾性分析，这些患者经超声心动图确诊后接受了紧急心包引流。首选的手术方式是微创剑突下液体引流并常规心包引流。进行回顾性手术数据分析：临床症状、入院前和初始急诊诊断及干预措施、引流心包液的形态和总量、住院时间、最终结果和总生存率。我们引入了一个原创的小儿压塞指数（PTI）。根据引流前儿茶酚胺支持情况和术后住院时间对PTI进行分析。
所有患者手术均存活。未发现所采用的微创剑突下手术方式有早期并发症。术前接受强化儿茶酚胺支持的患者的平均PTI显著高于未接受强化儿茶酚胺支持的患者。
微创剑突下手术干预似乎是一种安全有效的方法，可为挽救生命提供支持，并获取液体用于进一步实验室检查。
