Consultant Emergency Physician & ED Critical Care, Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia.
Consultant Emergency Physician & ED Critical Care, Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia.
Am J Emerg Med. 2021 Jul;45:688.e3-688.e7. doi: 10.1016/j.ajem.2021.01.022. Epub 2021 Jan 16.
Pericardial Decompression Syndrome (PDS) is an uncommon but life-threatening complication following pericardiocentesis for cardiac tamponade. We report PDS after pericardiocentesis in two patients that presented to the emergency department with cardiac tamponade. In both cases, pericardiocentesis was performed under ultrasound guidance using the left parasternal approach and approximately 1200-1500 mL of pericardial fluid was removed. Immediately after pericardiocentesis, the haemodynamic status of the patients improved. However, 2-3 h post decompression, both patients developed hypotension and pulmonary edema with reduced left ventricular function, suggestive of PDS. PDS is a condition that is described as paradoxical worsening of vital signs after successful decompression of the pericardium in the setting of acute tamponade. Three possible mechanisms explaining PDS are ischaemic, hemodynamic and autonomic processes. If PDS is unrecognized and untreated, it is associated with a high mortality rate secondary to pulmonary edema and cardiogenic shock. If managed urgently, the cardiopulmonary dysfunction in PDS is usually transient and largely reversible with supportive care.
心包减压综合征（PDS）是心脏压塞行心包穿刺术后少见但危及生命的并发症。我们报道了 2 例因心脏压塞而行心包穿刺术后发生 PDS 的患者，他们均因心脏压塞就诊于急诊科。在这 2 例患者中，均在超声引导下行左侧胸骨旁入路心包穿刺术，抽出约 1200-1500ml 心包积液。心包穿刺术后即刻，患者血流动力学状态改善。然而，减压后 2-3 小时，这 2 例患者均出现低血压和肺水肿，左心室功能降低，提示发生 PDS。PDS 是指在急性心脏压塞情况下成功减压后，生命体征出现矛盾性恶化的一种病症。解释 PDS 的可能机制有缺血、血流动力学和自主神经过程。如果未能识别和治疗 PDS，它可导致肺水肿和心源性休克，进而导致高死亡率。如果及时处理，PDS 的心肺功能障碍通常是短暂的，并且在支持性治疗下基本可以完全恢复。
