Alcan K E, Zabetakis P M, Marino N D, Franzone A J, Michelis M F, Bruno M S
JAMA. 1982 Feb 26;247(8):1143-8.
Eighteen patients with cardiac tamponade were treated by subxiphoid pericardiotomy performed with the patients under local anesthesia. This group included 9 cases of uremic pericarditis (50%), 5 cases of metastatic cancer (28%), 2 cases of trauma (11%), 1 case of tuberculosis (5.5%), and 1 case of unknown cause. Immediate relief from acute cardiac tamponade was obtained in all 18 cases with only minor and self-limiting postoperative complications, including transient supraventricular arrhythmias (five cases) and fever (five cases). There were no deaths related to either the operative procedure or reaccumulation of the pericardial effusion. The drainage period averaged 9.6 days (range, three to 28 days). Pericardial biopsy was performed in 15 of 18 cases. We conclude that subxiphoid pericardiotomy is a safe and effective method for the management of pericardial effusion of diverse causes. The ability to perform this technique safely using local anesthesia and the capacity to obtain a biopsy specimen under direct visualization make this technique superior to both needle pericardiocentesis and pericardiectomy in the acutely ill patient.
18例心包填塞患者在局部麻醉下接受剑突下心包切开术治疗。该组包括9例尿毒症性心包炎（50%）、5例转移性癌（28%）、2例创伤（11%）、1例结核（5.5%）和1例病因不明者。18例患者急性心包填塞均立即缓解，术后仅出现轻微且自限性的并发症，包括短暂性室上性心律失常（5例）和发热（5例）。无手术相关死亡或心包积液再积聚情况。引流时间平均为9.6天（范围3至28天）。18例中有15例进行了心包活检。我们得出结论，剑突下心包切开术是治疗多种病因心包积液的一种安全有效的方法。在局部麻醉下安全实施该技术的能力以及在直视下获取活检标本的能力，使该技术在急性病患者中优于心包穿刺术和心包切除术。
