非创伤性出血性心脏压塞的医学干预意义。

Significance of medical intervention for non-traumatic hemorrhagic cardiac tamponade.

机构信息

Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Japan.

出版信息

Am J Emerg Med. 2021 Dec;50:636-639. doi: 10.1016/j.ajem.2021.09.030. Epub 2021 Sep 24.

DOI:10.1016/j.ajem.2021.09.030

PMID:34879479

Abstract

BACKGROUND

The outcomes of patients with cardiac arrest induced by non-traumatic hemorrhagic cardiac tamponade are poor.

PURPOSE

We retrospectively investigated the significance of medical intervention with pericardiocentesis and/or pericardiotomy for non-traumatic hemorrhagic cardiac tamponade.

METHODS

From January 2013 to April 2021, we retrospectively reviewed the medical charts of all patients with cardiac arrest in a prehospital setting or emergency room due to cardiac tamponade confirmed by an ultrasound examination with or without an invasive procedure (pericardiocentesis and/or pericardiotomy) and computed tomography findings, including those obtained at autopsy imaging. The subjects were divided into two groups: the Intervention (+) group, which included subjects who underwent pericardiocentesis or pericardiotomy, and the Intervention (-) group, which included subjects who did not undergo pericardiocentesis or pericardiotomy. Variables were then compared between the two groups.

RESULTS

There were 68 patients with non-traumatic cardiac tamponade. All three survival cases had witnessed collapse, and the initial rhythm was pulseless electrical activity (PEA).There were no statistically significant differences in the sex, age, means of transportation, bystander chest compression, electric shock, or adrenalineor FDP levels between the two groups.However, the number with witnessed collapse, PEA, rupture of the heart;the ratio of obtaining return of spontaneous circulation; and the survival ratio were significantly greater in the Intervention (+) group than in the Intervention (-) group.

CONCLUSION

Based on the results of preliminary study, we hypothesized that invasive medical intervention for patients with cardiac arrest induced by non-traumatic hemorrhagic cardiac tamponade might be useful for obtaining return of spontaneous circulation and a survival outcome, especially for patients with witnessed collapse with PEA as the initial rhythm.

摘要

背景

非创伤性出血性心脏压塞导致的心脏骤停患者的预后较差。

目的

我们回顾性研究了经皮心包穿刺术和/或心包切开术对非创伤性出血性心脏压塞的治疗意义。

方法

2013 年 1 月至 2021 年 4 月，我们回顾性分析了所有因超声检查（包括有创操作：心包穿刺术和/或心包切开术）和计算机断层扫描检查证实的心脏压塞（包括尸检影像学检查）导致的院前或急诊心脏骤停患者的病历资料。患者分为两组：干预（+）组，行心包穿刺术或心包切开术；干预（-）组，未行心包穿刺术或心包切开术。比较两组间的变量。

结果

共纳入 68 例非创伤性心脏压塞患者。3 例存活患者均有目击者见证发病，初始节律为无脉性电活动（PEA）。两组间的性别、年龄、转运方式、旁观者胸外按压、电击除颤、肾上腺素或纤维蛋白（原）降解产物水平均无统计学差异。然而，干预（+）组中目击者见证发病、PEA、心脏破裂的患者比例更高，自主循环恢复率和存活率也更高。