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目的 总结经皮冠状动脉腔内成形术 (PTCA)治疗并发急性心包填塞的临床超声心动图特点。方法 对本院5例PTCA治疗后由超声心动图发现 ,最终经心包积液性质和 (或 )手术证实的冠状动脉穿孔并发急性心包填塞患者的临床资料进行回顾性分析。结果 5例患者在PTCA治疗后 2 0分钟～ 2小时突发胸闷、出汗、血压降低 ,而心率、呼吸、心电图明显变化 ,经快速补液和多巴胺治疗血压难以纠正 ;床旁超声心动图提示心包内 10～ 2 5mm心包积液 ;并指导紧急实施心包穿刺和持续引流术 ,4例经采取内科保守治疗成功 ;仍有活动性出血 ,而急诊实施了冠状动脉旁路移植术 ,并行冠状动脉缝合治疗。 5例均康复出院。结论 PTCA术后疑有急性心包填塞 ,应急诊床旁超声心动图检查。一经确诊 ,应紧急实施心包穿刺和持续引流术 ,连续观察引流效果 ,持续活动出血应急诊冠状动脉旁路移植术治疗
Objective To summarize the clinical echocardiographic features of percutaneous transluminal coronary angioplasty (PTCA) complicated with acute pericardial tamponade. Methods The clinical data of 5 patients with PTCA treated by echocardiography after percutaneous transluminal coronary angioplasty (PTCA) and finally confirmed by pericardial effusion and / or surgery were retrospectively analyzed. Results In 5 patients, chest tightness, sweating and blood pressure were suddenly decreased from 20 minutes to 2 hours after PTCA, while heart rate, respiration and electrocardiogram were significantly changed, and it was difficult to correct the blood pressure after rapid rehydration and dopamine treatment. The bedside echocardiography showed that the pericardium Within 10 ~ 2 5mm pericardial effusion; and guide the urgent implementation of pericardiocentesis and continuous drainage, 4 cases were taken conservative treatment of internal medicine success; still active bleeding, and the implementation of the emergency coronary artery bypass grafting, parallel suture of the coronary artery treatment. 5 cases were discharged. Conclusions There is a suspicion of acute pericardial tamponade and emergency bedside echocardiography after PTCA. Once confirmed, urgent implementation of pericardiocentesis and continuous drainage, continuous observation of the drainage effect, continuous active bleeding Emergency Department of Coronary Artery Bypass Grafting