冠状动脉介入伤与急心包填塞.ppt

冠状动脉介入损伤与急性心包填塞 Jun Dai , M.D. Coronary disease center Fuwai Heart Hospital CAMS PUMC China 内容 冠脉血管损伤概念 冠脉穿孔分类和处理原则 心包填塞病理生理 心包填塞的临床表现 心包填塞正确处理 总结 冠状动脉介入损伤及后果 冠状动脉夹层：内膜与中膜、中膜与外膜分离：血管壁血栓形成和管腔的闭塞 冠状动脉穿孔：亚急性心包积血或心包填塞，尤其充分抗血小板抗凝治疗的情况下 冠状动脉破裂：急性心包积血处理不及时急性心包填塞 Excluding case of Kawasaki d. traumatic injure Predictors Patient-related: female gender/ older age Vessel-related: tortuosity angulation calcification CTO Procedure-related: High balloon-stent ratio High inflation pressure Extremely distal location of the guidewire Device-related: Stiff wire/Hydrophilic-coated wire/cutting