Shyy William, Knight Roneesha S, Kornblith Aaron, Teismann Nathan A
Department of Emergency Medicine, San Francisco General Hospital, University of California, San Francisco, California, USA.
Department of Emergency Medicine, San Francisco Medical Center, University of California, San Francisco, California, USA.
J Ultrasound Med. 2017 Nov;36(11):2197-2201. doi: 10.1002/jum.14251. Epub 2017 May 15.
The presentation of cardiac tamponade is a spectrum from occult to extreme. The clinical history, physical exam, electrocardiogram, and radiographic findings of tamponade have poor sensitivities and even worse specificities. We use a clinical scenario to demonstrate how point-of-care cardiac ultrasound can diagnose impending cardiac tamponade in a clinically stable patient. The ultrasound finding we recommend is the flow velocity paradoxus, in which respiratory variation causes significant changes in transvalvular inflow velocities, which are exaggerated when tamponade is present. The management of a pericardial effusion depends on its physiologic effect, and point-of-care ultrasound directly measures that effect and expedites patient care.
心脏压塞的表现范围从隐匿到严重。心脏压塞的临床病史、体格检查、心电图和影像学表现敏感性较差，特异性更差。我们通过一个临床病例来展示床旁心脏超声如何诊断临床稳定患者即将发生的心脏压塞。我们推荐的超声表现是血流速度矛盾现象，即呼吸变化导致跨瓣流入速度发生显著变化，当存在心脏压塞时这种变化会更加明显。心包积液的处理取决于其生理效应，床旁超声可直接测量这种效应并加快患者的治疗。
