目的 探讨心脏介入手术并发急性心包填塞的原因、临床特征、诊断及处理方法.方法 回顾性分析2009-2012年住院行介入手术并发急性心包填塞的患者的临床资料,包括临床特征、原因、治疗及转归.结果 共有10例患者(其中男7例,平均年龄67岁)出现急性心包填塞,其中行冠状动脉支架植入术7例,三腔起搏器植入术1例,室性心动过速心外膜消融术1例,经皮主动脉瓣膜置换术1例.患者表现为胸痛、气促、大汗等症状;均出现血压下降,其中5例心率减慢,3例出现意识不清;10例患者均经超声或X线检查确诊为心包积液,紧急实施经皮Seldinger法剑突下行心包穿刺及置管引流,引流出不凝血性液体250~2 000 ml,猪尾导管留置时间24~72 h,必要时给予输血、多巴胺维持血压等治疗.全部抢救成功.结论 急性心包填塞是心脏介入手术的严重并发症,早期识别非常重要,紧急超声指导下心包穿刺、引流及其他正确处理是抢救成功的关键.%Objective To analyze the causes, differential diagnosis and management of acute cardiac tamponade caused by cardiac intervention. Methods Data of patients with acute pericardial temponade caused by cardiac intervention admitted from 2009 to 2012 were analyzed retrospectively to find its clinical features, reasons, treatment and outcomes. Results A total of 10 patients ( including 7 males, at an average age of 67 ) presented with acute pericardial temponade, thereinto 7 had coronary stent implantation, 1 had 3 - chamber pacemaker implantation, 1 had ventricular tachycardia epicardial ablation, 1 had percutaneous aortic valve replacement. The patients had chest pain, shortness of breath, sweating and other symptoms with low blood pressure, 5 of them had decreased heart rate, 3 were unconscious. Ten were diagnosed as pericardial effusion by ultrasound or X -ray and successfully rescued after percutaneous Seldinger's pericardiopuncture and drainage. Conclusion Acute cardiac tamponade, a severe complication in cardiac interventional procedures, requires timely diagnosis and appropriate treatment to a-void life - threatening consequences.
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