Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Curr Cardiol Rep. 2020 Jun 19;22(8):60. doi: 10.1007/s11886-020-01324-y.
This review summarizes the optimal techniques for the performance of pericardiocentesis in contemporary practice, highlighting the indications, contraindications, and techniques used. Routine pericardial catheter management and the diagnostic role of pericardial fluid analysis are described.
Echocardiographic-guided pericardiocentesis should be considered the therapy of choice in current clinical practice and may be performed safely despite the presence of coagulopathy and thrombocytopenia in the hands of expert operators. Computed tomography (CT)-guided techniques may provide a useful adjunctive tool in patients with poor acoustic windows or complex loculated effusions. Conservative management utilizing pericardiocentesis may be considered in select patients with device lead and interventional-related pericardial effusions. Echocardiographic-guided pericardiocentesis with extended pericardial drainage (goal output < 50 mL/24 h) should be considered the standard of care in contemporary practice. Pericardial fluid analysis should be tailored based on the clinical history and appearances of the pericardial fluid.
本文总结了当代实践中行心包穿刺术的最佳技术，重点介绍了适应证、禁忌证和所用技术。还描述了心包引流的常规管理和心包液分析的诊断作用。
在当前临床实践中，超声心动图引导下心包穿刺术应被视为首选治疗方法，即使在经验丰富的术者手中存在凝血障碍和血小板减少，其操作也可安全进行。对于声窗不佳或复杂分隔性积液的患者，CT 引导技术可能是一种有用的辅助工具。对于特定的因器械导丝和介入相关的心包积液而选择保守治疗的患者，可以考虑进行心包穿刺术。在当代实践中，应将超声心动图引导下持续心包引流（目标引流量＜50 mL/24 h）的心包穿刺术作为标准治疗方法。应根据心包积液的临床病史和外观来调整心包液分析。
