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目的探讨冠心病经皮冠状动脉介入治疗(PCI)并发冠状动脉穿孔致急性心脏压塞的临床特征、处理方法,以提高抢救成功率。方法回顾性分析2005年1月至2015年12月在新疆维吾尔自治区人民医院心内科住院行PCI时并发冠状动脉穿孔导致急性心脏压塞的冠心病患者13例,分析发生原因、临床表现、处理方法及预后。结果所有患者均得到及时诊断,心包穿刺均获得成功,心包腔内注入凝血酶冻干粉500~1000 U得到有效止血,术后2 h、4 h、6 h、24 h及出院前复查心脏超声未发现新的心包积液及心包粘连。所有患者出院后6个月随访心脏超声未见心包缩窄或粘连。结论急性心脏压塞是PCI术中严重的并发症之一,一旦诊断明确,需紧急心包穿刺引流。心包腔内注入凝血酶能成功止血,提高抢救成功率。
Objective To investigate the clinical characteristics and treatment of acute cardiac tamponade caused by percutaneous coronary intervention (PCI) complicated with coronary artery perforation in coronary heart disease (CHD) to improve the success rate of rescue. Methods A retrospective analysis of 13 patients with coronary heart disease who underwent percutaneous coronary artery perforation in hospitalizations of cardiology department of People’s Hospital of Xinjiang Uyghur Autonomous Region from January 2005 to December 2015 were retrospectively analyzed. The causes, clinical manifestation and treatment methods were analyzed And prognosis. Results All the patients were diagnosed in time and the pericardiocentesis was successful. The percutaneous transluminal injection of 500 ~ 1000 U of thrombin lyophilized powder was effective for hemostasis. The echocardiography was performed at 2 h, 4 h, 6 h, 24 h and before discharge No new pericardial effusion and pericardial adhesions were found. All patients were discharged at 6 months after echocardiography, no constriction or adhesions. Conclusions Acute cardiac tamponade is one of the serious complications in PCI. Once the diagnosis is clear, urgent pericardial drainage is required. Pericardial injection of thrombin can successfully stop bleeding, improve the success rate of rescue.