心内直视术后心包填塞23例的临床诊治分析.DOCVIP

临床医学论文-心内直视术后心包填塞23例的临床诊治分析 ????? 作者：唐白云 杨圣艮 刘喜利? 张希 罗红鹤 王治平 熊迈 陈光献 童萃文 孙培吾 【摘要】 目的? 探讨心内直视术后心包填塞的原因、临床表现、早期诊治方法和预防。 方法? 回顾性复习1996年1月～2003年12月心内直视术后30例疑为心包填塞而行二次（开胸）探查术患者的临床资料，对血压、心率、中心静脉压、pH值等一些重要参数进行了统计学分析。并将其分为两组:T组（心包填塞组23例）和C组（非心包填塞组7例），T组包括19例急性心包填塞（含6例局限性心包填塞 ［1］ ）和4例延迟性心包填塞。 结果? 经二次探查后17例康复出院，13例死亡（其中T组7例，C组6例）。两组患者在探查前心率、中心静脉压均显著增高（P0.05），血压、脉压差、尿量均明显下降（P0.05），T组对血管活性药物反应差;在心包探查后T组血压、尿量迅速回升（P0.01），心率、中心静脉压明显回落（P0.01），C组除pH、碱剩余显著下降（P0.05），心率进一步增快（P0.05）外，其余指标变化不明显（P0.05）。与T组相比C组探查后血压、碱剩余、氧分压均较低（P0.05），探查引流总量显著少于T组（P0.01），死亡率明显高于T组（P0.05）。 结论? 心内直视术后心包填塞的临床表现主要为非特异性血流动力学紊乱;及时准确的诊断有赖于对其进行动态观察分析，并应排除心源性低心排出量综合征（LCOS）。紧急心包探查仍是解除术后急性心包填塞的主要方法，心包穿刺抽液适用于延迟性心包填塞。 ??? 关键词? 心内直视术 二次（开胸）探查 心包填塞 ??? Clinical diagnosis and therapeutics of23cases of pericardial ??? 【Abstract】 Objective To discuss the cause，clinical characteristics，management，early diagnosis and pro-phylaxis of pericardial tamponade after open-heart surgery.Methods The clinical data of30patients undergoing re-exploration with clinical suspicion of pericardial tamponade after open-heart surgery from Jan.1996to Dec.2003were reviewed，and related parameters such as BP，HR，CVP，pH and some other records were analyzed.And accord-ing to the re-exploration30patients were divided into2groups:T（tamponade）group including19acute pericardial tamponade（6regional cardiac tamponade）and4delayed cardiac tamponade，and C（control）group（7cases）.Re-sults 17patients were recovered from re-exploration，and13died（7cases in T group，6cases in C group）.HR and CVP in2groups increased significantly（P0.05）before re-exploration when compared with returning to ICU，meanwhile BP，PP and urine were much decreased（P0.05），and those response were very poor for vasoactive agents in Tgroup.As re-exploration was performed，BP，PP and urine in Tgroup raised soon（P0.05）while HR，CVP was coming down quickly（P0.05）.On the contrary，change of the corresponding parameters in C group was uncer-tain，except for pH，BE decreased and HR even became faster（P0.05）.Compa