Daugirdas J T, Leehey D J, Popli S, McCray G M, Gandhi V C, Pifarré R, Ing T S
Arch Intern Med. 1986 Jun;146(6):1113-5.
Sixteen patients receiving maintenance hemodialysis in whom moderate-to-large pericardial effusions developed were treated with short-term drainage via a large-bore tube implanted into the pericardial sac. Drainage tubes were implanted using a subxiphoid approach (subxiphoid pericardiostomy) while the patient was under local anesthesia. In seven patients, triamcinolone hexacetonide was instilled into the pericardial sac through the drainage tube at regular intervals. In all patients, a drainage period of two to four days, with or without instillation of nonabsorbable steroids, was associated with resolution of the pericardial effusion. Only one recurrence of effusion was demonstrable over a follow-up period extending from three months to eight years (median, 4.2 years). Complications of subxiphoid pericardiostomy were minor (incisional hernia, wound infection, and small pneumothorax) and easily treatable. Our results suggest that short-term drainage via a surgically implanted drainage tube is an effective and safe treatment of moderate-to-large hemodialysis-associated pericardial effusion.
16例接受维持性血液透析且出现中至大量心包积液的患者，通过植入心包腔的大口径导管进行短期引流治疗。在局部麻醉下，采用剑突下途径（剑突下心包造口术）植入引流管。7例患者通过引流管定期向心包腔内注入己曲安奈德。所有患者，无论是否注入不可吸收类固醇，引流2至4天均使心包积液消退。在3个月至8年（中位时间4.2年）的随访期内，仅1例出现积液复发。剑突下心包造口术的并发症轻微（切口疝、伤口感染和小气胸）且易于治疗。我们的结果表明，通过手术植入引流管进行短期引流是治疗中至大量血液透析相关心包积液的一种有效且安全的方法。
