Shore D F, Capuani A, Lincoln C
J Thorac Cardiovasc Surg. 1982 Mar;83(3):449-52.
A state clinically indistinguishable from cardiac tamponade can occur after operation for congenital heart disease in the absence of intrapericardial blood or clot. We have employed a method of splinting the sides of the sternum apart in nine patterns in whom low-output states developed postoperatively, unresponsive to either inotropic drugs or vasodilator therapy. Blood pressure, heart rate, central venous pressure, urine output, toe temperature, and arterial PO2 immediately before and 90 minutes after the procedure were compared. Significant increases in blood pressure (p less than 0.02), urine output (p less than 0.001), and toe temperature (p less than 0.001) and a significant fall in central venous pressure (p less than 0.001) resulted. The figures indicate a marked improvement in cardiac output which occurred without alteration in inotropic support or after load reduction. We conclude that mechanical restriction of ventricular relaxation can occur in the absence of intrapericardial blood or clot, may contribute to low-output states, and can be successfully managed by sternal splintage.
在先天性心脏病手术后，即使心包内没有血液或血凝块，也可能出现一种在临床上与心脏压塞无法区分的状态。我们采用了一种方法，将胸骨两侧撑开，共9例术后出现低输出状态且对强心药物或血管扩张剂治疗均无反应的患者采用了该方法。比较了手术前及手术后90分钟时的血压、心率、中心静脉压、尿量、趾温及动脉血氧分压。结果血压显著升高（p<0.02）、尿量显著增加（p<0.001）、趾温显著升高（p<0.001），中心静脉压显著下降（p<0.001）。这些数据表明心输出量有显著改善，且这一改善是在未改变强心支持或降低后负荷的情况下出现的。我们得出结论，在心包内没有血液或血凝块的情况下，可能会发生心室舒张的机械性受限，这可能导致低输出状态，而胸骨撑开固定术可成功处理这种情况。
