Melvan John Nicholas, Madden David, Vasquez Julio C, DeLaRosa Jacob
Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA.
Idaho State University, Portneuf Medical Center, Pocatello, ID, USA.
Heart Lung Circ. 2016 Jul;25(7):725-8. doi: 10.1016/j.hlc.2016.01.004. Epub 2016 Feb 6.
Pericardial effusions compress the heart, decrease cardiac output, and lead to haemodynamic collapse. Ultrasound (US)-guided pericardiocentesis is the gold standard for treating pericardial effusions. Recently, the incorporation of computed tomography (CT) guidance has increased patient safety while entering the pericardium. Despite the superior performance of CT-guided pericardiocentesis in smaller, complex effusions, this procedure is not routinely performed by cardiologists and surgeons. Unlike those with an intact pericardium, patients with mediastinal trauma, pericardial adhesions, temporary pacing wires, and vascular conduits are high risk for pericardiocentesis. Tamponade physiology also increases patient susceptibility to the hypotensive effects of anaesthesia during surgical drainage. Here we illustrate the technique of CT-guided pericardiocentesis and demonstrate its application in specific clinical scenarios. We conclude that CT-guided pericardiocentesis provides a useful, alternative strategy for treating cardiac tamponade in high risk patients.
心包积液会压迫心脏，降低心输出量，并导致血流动力学崩溃。超声（US）引导下心包穿刺术是治疗心包积液的金标准。最近，计算机断层扫描（CT）引导的应用提高了进入心包时的患者安全性。尽管CT引导下心包穿刺术在较小的、复杂的积液中表现更优，但心脏病专家和外科医生并不常规进行此操作。与心包完整的患者不同，纵隔创伤、心包粘连、临时起搏导线和血管导管患者进行心包穿刺术的风险很高。心脏压塞生理状态也会增加患者在手术引流期间对麻醉低血压效应的易感性。在此，我们阐述CT引导下心包穿刺术的技术，并展示其在特定临床场景中的应用。我们得出结论，CT引导下心包穿刺术为治疗高危患者的心包填塞提供了一种有用的替代策略。
