Vayre F, Lardoux H, Koukoui F, Ollivier J P, Pezzano M
Service de Cardiologie, Hôpital Gilles de Corbeil, Corbeil-Essonnes.
Presse Med. 1997 Jun 28;26(22):1036-9.
Transthoracic echoguided puncture of the pericardium can be an alternative to surgical drainage. We report our experience with this technique acquired over the last 11 years.
From January 1984 to September 1995, 34 consecutive patients in the cardiology intensive care unit (mean age 56.5 +/- 13 years) underwent echoguided pericardial puncture for poorly tolerated pericardial effusion. The underlying cause was neoplasia (n = 22), idiopathic disease (n = 5), autoimmune disease (n = 2), post-surgical complication (n = 2 including 1 on hemodialysis), infection (n = 1), antivitamin K therapy (n = 1) and disseminated vascular coagulation (n = 1). The subxyphoid (n = 33) or left parasternal (n = 1) route was used under echographic guidance. Intrapericardial contrast allowed verification of the catheter position. The mean quantity of fluid removed was 585 +/- 390 ml. The fluid was hemorrhagic (n = 19), clear (n = 10) or serohematic (n = 4). Aspiration was continued in 16 patients after the initial puncture for a mean 64 hours. The mean total volume of fluid was 750 +/- 330 ml.
There was one death during puncture which was found to be unrelated to the procedure after anatomic verification. In two cases, the left ventride was punctured without any consequence. Collapsus occurred during puncture in 2 patients with pulmonary sepsis. Minor incidents were: 6 vasovagal syndromes at puncture with paroxysmal supraventricular rhythm disorder during aspiration. Prior to 1988, surgical drainage was required in 5 patients for persistent or recurrent effusion. Since that time, continuous aspiration has been used in all patients and no surgical drainage has been required. Short-term prognosis depends on the underlying cause (6 deaths at 1 month).
Echoguided pericardial puncture is a simple procedure which rapidly improves cardiac hemodynamics in these particularly fracle patients. Continuous aspiration avoids subsequent surgical drainage for persistent or recurrent effusion.
经胸超声引导下心包穿刺可作为手术引流的替代方法。我们报告过去11年中应用该技术的经验。
1984年1月至1995年9月，连续34例入住心脏病重症监护病房的患者（平均年龄56.5±13岁）因心包积液耐受性差接受超声引导下心包穿刺。病因包括肿瘤（n = 22）、特发性疾病（n = 5）、自身免疫性疾病（n = 2）、术后并发症（n = 2，其中1例接受血液透析）、感染（n = 1）、抗维生素K治疗（n = 1）和弥散性血管内凝血（n = 1）。在超声引导下采用剑突下途径（n = 33）或左胸骨旁途径（n = 1）。心包内造影可验证导管位置。抽出液体的平均量为585±390 ml。液体为血性（n = 19）、清亮（n = 10）或血清血性（n = 4）。16例患者在首次穿刺后持续抽吸，平均抽吸64小时。液体的平均总量为750±330 ml。
穿刺过程中有1例死亡，解剖证实与操作无关。2例患者穿刺入左心室，但未造成任何后果。2例肺部感染患者在穿刺时发生虚脱。轻微事件包括：6例穿刺时出现血管迷走神经综合征，抽吸时出现阵发性室上性心律失常。1988年前，5例患者因持续性或复发性积液需要手术引流。自那时起，所有患者均采用持续抽吸，无需手术引流。短期预后取决于潜在病因（1个月内6例死亡）。
超声引导下心包穿刺是一种简单的操作，可迅速改善这些特别虚弱患者的心脏血流动力学。持续抽吸可避免因持续性或复发性积液而进行后续手术引流。
