冠状动脉介入损伤与急性心包填塞PPT课件.pptx

冠状动脉介入损伤与急性心包填塞1

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2

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ExcludingcaseofKawasakid.traumaticinjure3

PredictorsPatient-related:femalegender/olderageVessel-related:tortuosityangulationcalcificationCTOProcedure-related:Highballoon-stentratioHighinflationpressureExtremelydistallocationoftheguidewireDevice-related:Stiffwire/Hydrophilic-coatedwire/cuttingballoon/atheroablativedevices/Ivus4

ClassificationofcoronaryperforationproposedbyEllisetal1994TypeI:extraluminalcraterwithoutextravasationTypeⅡ:pericardialormyocardialblushwithoutcontrastjetextravasationTypeⅢ:extravasationthroughfrank(≥1mm)perforationCavityspilling:perforationintoanatomiccavitychambercoronarysinusAs5

TreatmentTypeI1.15-30mincarefulobervation2.noenlargeordiminish,nofurtheraction3.protamine(1mgper100uheparin)ACT150,hemostaticPLfunctiontorestorewhenⅡb/Ⅲareceptoroccupanyfallsto50%6

TypeⅡPerfusionballooncathertosealUCGwithoutdelayReversalofanticoagulation:protaminetransfusioninPsreceivedabciximabPericardiocentesiswithtamponade/PTFE-coveredstentCardiacsurgeryreadyfornoachiveveinghemostasis7

TypeⅢBallooninflation5-10mintoprovidetimeforthepreparationofperfusionballonandpericardiocentesisMustbecompletelysealedwithcoveredstentImmediateaggressivetreatment:volumeresuscitation,catecholamines,pericardiocentesisImmediatereversalofanticoagulation:protamine/PLtransfusioninabciximab-tratment8

PathophysiologyThepericardium,whichisthemembranesurroundingtheheart,iscomposedof2layers.Theparietalpericardiumistheouterfibrouslayer;thevisceralpericardiumistheinnerserouslayer.Thepericardialspacenormallycontains20-50mLoffluid.9

心包积液与心包填塞心包腔内液体量增加称心包积液。当心包腔内液体量增加到一定程度，心包腔内的压力随之升高，达