Suehiro S, Kimura E, Shibata T, Minamimura H, Sasaki Y, Hattori K, Kumano H, Kinoshita H
Second Department of Surgery, Osaka City University Medical School, Japan.
Kyobu Geka. 1996 Feb;49(2):105-10.
Late pericardial effusion (PE) after open heart surgery has a potential for serious complications, including tamponade necessitating urgent drainage. From October 1990 to March 1995 moderate to massive PE developed following 9 of 359 (2.5%) cardiac procedures between 11 and 55 days postoperatively (mean, 18.6 days). Only one of these nine patients had evidence of cardiac tamponade; the other 8 patients had moderate symptoms including malaise, weight gain, and dyspnea on exertion. All patients except one were being treated with warfarin and anti-platelet agents. Echocardiography detected posterior PE of variable magnitude in all 9 patients; anterior PE was present in only one of these patients. Pericardiocentesis under echocardiographic guidance using an echo transducer with a built in puncture needle was performed in all patients. A flexible catheter was left in place for 24 to 72 hours for suction. In each case, 300 to 712 ml of old bloody fluid (mean, 475 ml) was evacuated, with relief of symptoms. Despite continuing anticoagulant therapy, there was no recurrence of pericardial effusion. The technique we have described simplifies pericardiocentesis and helps to avoid complications in this procedure.
心脏直视手术后晚期心包积液（PE）有引发严重并发症的可能，包括需要紧急引流的心脏压塞。1990年10月至1995年3月，359例心脏手术中有9例（2.5%）在术后11至55天（平均18.6天）出现中度至大量心包积液。这9例患者中只有1例有心脏压塞的证据；其他8例患者有中度症状，包括不适、体重增加和劳力性呼吸困难。除1例患者外，所有患者均接受华法林和抗血小板药物治疗。超声心动图检查发现所有9例患者均有不同程度的后壁心包积液；其中只有1例患者有前壁心包积液。所有患者均在超声心动图引导下，使用带有内置穿刺针的超声探头进行心包穿刺。留置一根软导管24至72小时用于抽吸。每例患者抽出300至712毫升陈旧性血性液体（平均475毫升），症状缓解。尽管继续进行抗凝治疗，但心包积液未复发。我们所描述的技术简化了心包穿刺术，并有助于避免该操作中的并发症。
