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[早产儿中心静脉置管致心包积液的临床分析]

[A clinical analysis of pericardial effusion caused by central venous catheterization in preterm infants].

作者信息

Zhang Ya-Hui, Liu Yun-Feng, Tong Xiao-Mei, Lu Dan-Fang, Shi Shi

机构信息

Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China.

出版信息

Zhongguo Dang Dai Er Ke Za Zhi. 2021 Mar;23(3):259-264. doi: 10.7499/j.issn.1008-8830.2011089.

Abstract

OBJECTIVE

To study the clinical features of pericardial effusion caused by central venous catheterization in preterm infants.

METHODS

A retrospective analysis was performed on 11 preterm infants with pericardial effusion caused by central venous catheterization. Their catheterization features, manifestations, treatment, and prognosis were analyzed.

RESULTS

A total of 11 preterm infants (11/2 599, 0.42%) developed pericardial effusion, with a mean gestational age of (30.1±2.6) weeks and a mean birth weight of (1 240±234) g. Pericardial effusion mostly occurred within 4 days after central venous catheterization (10 cases, 91%). The main manifestations included poor response (6/11, 55%), cyanosis (5/11, 45%), increased respiratory rate (6/11, 55%), increased heart rate (6/11, 55%), aggravated dyspnea (5/11, 45%), and muffled heart sound (5/11, 45%). At the time of disease progression, 7 preterm infants (64%) had a deep position of the end of the catheter, 3 preterm infants (27%) had a correct position, and 1 preterm infant (9%) had a shallow position. Five preterm infants (45%) experienced cardiac tamponade, among whom 4 underwent pericardiocentesis. Seven preterm infants were given conservative medical treatment. Among the 11 children, 2 (18%) died and 9 (82%) improved.

CONCLUSIONS

Pericardial effusion caused by central venous catheterization mostly occurs in the early stage of catheterization and has critical clinical manifestations. Pericardiocentesis is required for cardiac tamponade, and early diagnosis and intervention can effectively improve prognosis.

摘要

目的

研究早产儿中心静脉置管致心包积液的临床特点。

方法

对11例因中心静脉置管导致心包积液的早产儿进行回顾性分析。分析其置管特点、临床表现、治疗及预后。

结果

共11例早产儿(11/2 599,0.42%)发生心包积液,平均胎龄(30.1±2.6)周,平均出生体重(1 240±234)g。心包积液多发生在中心静脉置管后4天内(10例,91%)。主要表现为反应差(6/11,55%)、发绀(5/11,45%)、呼吸频率增快(6/11,55%)、心率增快(6/11,55%)、呼吸困难加重(5/11,45%)及心音低钝(5/11,45%)。病情进展时,7例早产儿(64%)导管末端位置深,3例早产儿(27%)位置正确,1例早产儿(9%)位置浅。5例早产儿(45%)发生心脏压塞,其中4例接受心包穿刺术。7例早产儿接受保守药物治疗。11例患儿中,2例(18%)死亡,9例(82%)好转。

结论

中心静脉置管致心包积液多发生在置管早期,临床表现危急。心脏压塞需行心包穿刺术,早期诊断及干预可有效改善预后。

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