Vayre F, Lardoux H, Chikli F, Pezzano M, Bourdarias J P, Koukoui F, Ollivier J P, Dubourg O
Service de cardiologie, hôpital Ambroise Paré, Boulogne.
Arch Mal Coeur Vaiss. 1998 Jan;91(1):13-20.
Between April 1982 and December 1995, 78 consecutive patients with an average age of 57 +/- 13 years underwent echo-guided pericardiocentesis in the intensive care unit for poorly tolerated pericardial effusions. The patients were admitted to the cardiology departments of Ambroise-Paré Hospital at Boulogne (n = 44). Gilles-de-Corbeil Hospital at Corbeil-Essonnes (n = 31) and Val-de-Grâce Hospital in Paris (n = 3). The underlying aetiologies were malignant disease (n = 31), idiopathic (n = 13), post-surgery (n = 7), infection (n = 7), autoimmune (n = 6), post-radiotherapy (n = 6), post-myocardial infarction (n = 3), chronic renal failure (n = 3) and coagulation defects (n = 2). Pericardial puncture was undertaken by the subxiphoid (n = 77) or left parasternal (n = 1) approaches under guidance of echocardiography. Intra-pericardial contrast was used to verify the position of the catheter. The average volume of liquid drained was 580 +/- 390 mL. After pericardiocentesis, continuous drainage was continued in 17 patients for an average duration of 63 +/- 29 hours. The total average volume was 750 +/- 330 mL. The major complications were a) three deaths during the puncture, not caused by the procedure after post-mortem study, b) ten right ventricular punctures with no consequences in 9 cases, c) two cases of shock, one of which was due to a pre-existing septicaemia of pulmonary origin, d) two non-sustained ventricular arrhythmias. The minor incidents were six vasovagal syndromes during the procedure and four paroxysmal supraventricular arrhythmias. Emergency surgical drainage was required (n = 3) for a failed procedure and late surgical drainage (n = 12) for persistence or recurrence of the effusion. No surgical drainage was required in the 17 patients placed under continuous aspiration. Echo-guided pericardiocentesis is a simple procedure and provides rapid haemodynamic relief in subjects generally in serious condition. Continuous aspiration may help avoid the need for surgical drainage for persistence or recurrence of the effusion.
1982年4月至1995年12月期间，78例平均年龄为57±13岁的连续患者因心包积液耐受性差，在重症监护病房接受了超声引导下心包穿刺术。这些患者分别入住布洛涅的安布罗斯 - 帕雷医院心内科（n = 44例）、科尔贝伊 - 埃松讷的吉勒斯 - 德 - 科尔贝伊医院（n = 31例）和巴黎的瓦尔德格拉斯医院（n = 3例）。潜在病因包括恶性疾病（n = 31例）、特发性（n = 13例）、术后（n = 7例）、感染（n = 7例）、自身免疫性（n = 6例）、放疗后（n = 6例）、心肌梗死后（n = 3例）、慢性肾功能衰竭（n = 3例）和凝血缺陷（n = 2例）。心包穿刺在超声心动图引导下经剑突下（n = 77例）或胸骨旁左侧（n = 1例）途径进行。心包内注入造影剂以确认导管位置。抽出液体的平均量为580±390 mL。心包穿刺术后，17例患者持续引流，平均持续时间为63±29小时。总平均量为750±330 mL。主要并发症包括：a）穿刺过程中有3例死亡，尸检研究后发现并非由操作引起；b）10例右心室穿刺，9例无不良后果；c）2例休克，其中1例是由于先前存在的肺源性败血症；d）2例非持续性室性心律失常。轻微事件包括操作过程中的6例血管迷走神经综合征和4例阵发性室上性心律失常。因操作失败需要紧急手术引流（n = 3例），因积液持续或复发需要延迟手术引流（n = 12例）。17例持续抽吸的患者无需手术引流。超声引导下心包穿刺术是一种简单的操作，能为病情通常较重的患者迅速缓解血流动力学异常。持续抽吸可能有助于避免因积液持续或复发而需要手术引流。
