van Ditzhuyzen O, Ronayette D
Service de pédiatrie II, CHRU Dupuytren, Limoges, France.
Arch Pediatr. 1996 May;3(5):463-5. doi: 10.1016/0929-693x(96)86406-2.
Cardiac tamponade due to an intrapericardial infusion is a serious complication of central venous catheterization.
An infant born at 35 weeks of gestation age, weighing 2300 g, was operated on at H10 for a duodenal stenosis. On day 2, a polyurethane central venous catheter was inserted for parenteral nutrition via his right internal jugular vein. A frank blood return was obtained and a chest X-ray taken 2 hours later showed that the tip into the catheter was in the right ventricle. Four hours after insertion, a sudden deterioration of the infant's status led to tracheal intubation and artificial ventilation on 100% oxygen; no improvement was noted. The heart rate was 135 bpm, but the differential blood pressure was decreased at 68/56 mmHg and there was no blood return on the catheter. Cardiac tamponade was then suspected and immediately confirmed by pericardial tap that yielded 10.5 mL of the infused solution. The catheter tip was then repositioned and a good blood return was obtained. The infant's breathing and hemodynamic status improved dramatically.
The use of very thin and flexible central venous catheters does not eliminate the risk of perforation of the cardiac chambers. A cardiac tamponade must always be considered in children with a central venous catheter when a sudden deterioration of hemodynamic status is noted.
心包内输注导致的心包填塞是中心静脉置管的严重并发症。
一名孕35周出生、体重2300克的婴儿在H10接受十二指肠狭窄手术。术后第2天，经右侧颈内静脉插入一根聚氨酯材质的中心静脉导管用于肠外营养。回血顺畅，2小时后拍摄的胸部X线片显示导管尖端位于右心室。置管4小时后，婴儿病情突然恶化，导致气管插管并给予100%氧气人工通气；病情无改善。心率为135次/分钟，但动脉压差降至68/56毫米汞柱，导管无回血。随后怀疑有心包填塞，心包穿刺抽出10.5毫升输注液，立即确诊。然后重新调整导管尖端位置，回血良好。婴儿的呼吸和血流动力学状态显著改善。
使用非常细且柔软的中心静脉导管并不能消除心腔穿孔的风险。当中心静脉置管儿童出现血流动力学状态突然恶化时，必须始终考虑心包填塞的可能。
