心包穿刺引流术临床应用观察

我院心内科自1998年2月至2006年3月改良心包积液穿刺方法,经皮心包穿刺置管引流术治疗心包积液,取得较好的社会效益和经济效益,本方法与传统心包穿刺比较,具有安全性高,疗效好等优点,适用于基层医院,值得推广.报道如下.     

改良心包穿刺置管引流术42例的观察与护理

正常心包腔内可有少量液体（25ml～35m1）。由于某些因素的影响，心包内的积液迅速增加超过一定水平，造成心包积液，出现明显心包填塞症状，血压下降，休克甚至威胁生命。我科自1998年2月安排了“改良心包穿刺置管引流术”的科研计划，此法与传统心包穿刺引流术比较具有减少穿刺的重复性，减少并发症和感染机会，减轻患者痛苦，缩短病程，节约费用，效果突出等优点。现将临床观察及护理体会报告如下：     

心包穿刺置管引流治疗老年心包积液30例报告

心包积液是老年患者较为常见的疾病，其起病有时比较隐匿，早期临床表现不太典型，容易混淆，而当发展为心包填塞时，则需心包穿刺或切开引流，切开引流常由于创伤大易引起感染，而且老年患者手术耐受性差，因此不能作为一个常规手段。本文通过心包穿刺置管引流的方法治疗...     

48例B超引导下心包穿刺置管在心包积液诊治中的临床应用

目的探讨B超引导下经皮心包穿刺置管持续引流心包积液的疗效及安全性。方法对48例心包积液病人行B超检查,并在B超引导下进行置入中心静脉导管引流。结果 48例心包积液病人全部安全有效、置管成功。症状迅速缓解,可长期保留（4～16天）。结论 B超引导下经皮心包积液置管法简单、安全、有效,便于临床应用。     

Seldinger技术指导心包穿刺置管引流治疗心包积液

目的 评价Seldinger技术指导心包穿刺置管引流治疗中至大量心包积液的疗效及安全性。方法 中到大量心包积液48例,在超声心动图定位下,采用Seldinger技术,经皮穿刺心包腔并内置深静脉留置导管进行持续或间断引流心包积液。结果 48例患者均1次穿刺并留置导管引流成功．未出现因继发感染、出血、气胸、严重心律失常、心脏穿破及与心包穿刺置管导致的死亡。留置时间时间5～42（10．7±4．7）d,平均引流量为280～1750（590±160）ml。结论 采用Seldinger技术心包穿刺置管引流治疗中至大量心包积液,方法简单,安全有效,成功率高,可替代传统穿刺方法。     

心包穿刺置管引流部位与其安全性及引流程度关系的探讨

2002年1月-2005年10月,我们对56例中等量以上心包积液患者行心包穿刺并心包腔内置管间断引流术,并对不同心包穿刺置管引流部位的安全性及心包积液引流量进行比较,以取得更好的临床疗效。     

Seldinger导管法心包穿刺置管引流治疗心包积液25例

心包穿刺是治疗心包积液的重要方法之一 ,传统的心包穿刺有一定的危险性 ,1 997年 2月～2 0 0 0年 7月来 ,我们采用 Seldinger导管法 [1]进行心包穿刺抽液 ,为 2 5例心包积液患者安全地施行了心包穿刺留置单腔中心静脉导管引流治疗 ,取得了较好的效果 ,现报道如下 :1　资料与方法1 .1　临床资料 :1 .1 .1　本组全部为住院患者 ,并经 X线检查心影扩大 ,术前均以二维超声确认有心包积液 ,2 5例中男 1 8例 ,女 7例 ,年龄 1 7～ 73岁。心包积液量中等以上并伴有心包填塞症状 1 5例。1 .1 .2　病因 :癌性心包炎 8例 (均示大量心包积液 ) ,结核性…     

心包穿刺置管法在心包积液诊治中的应用

目的 讨论心包穿刺置管法在心包积液诊治中的应用。方法 经B超引导或定位在心尖部或剑突下置人中心静脉导管引流。结果 40例心包积液患者全部安全有效置管成功，得到有效救治。8例心包填塞患者引流后症状迅速缓解。可长期保留（5～30天）。操作并发症少。结论 床边心包积液置管法简单、安全、有效、经济，便于l临床应用。     

心包穿刺置管引流术误入右心室一例

患者女,48岁,于2009年10月6日无诱因出现发热、胸痛、呼吸困难。4 d后加重,出现频繁咳嗽,不能平卧,来院就诊。查体：体温38.6℃,呼吸26次/min,血压106/78 mm Hg（1 mm Hg=0.133 kPa）,慢性病容,痛苦表情,无巩膜黄染,无浅表淋巴结肿大,口唇轻度发绀,颈静脉充盈,心界向两侧扩大,心率110次/min,律齐,心音低钝遥远,无心包摩擦音,     

心包穿刺置管引流治疗心包积液的护理

目的探讨心包经皮穿刺置管引流治疗心包积液的护理。方法对10例心包积液患者应用中心静脉导管进行心包穿刺并置管引流,加强术前护理,术中配合,置管后做好体位、留置导管、心理及生活方面的护理指导并密切观察病情。结果10例心包积液患者经皮穿刺置管术均穿刺成功,导管留置时间5～20d,中位时间12d。置管后2例出现穿刺处渗液,1例出现导管松脱,2例发生导管堵塞。结论心包经皮穿刺置管引流是治疗心包积液的安全、有效的方法,做好术前、术中、术后观察和护理,使患者积极配合,可减少并发症的发生,提高患者的生存质量。     

Closed pericardial drainage for relief of pericardial tamponade

The method of continuous catheter drainage for pericardial tamponade as used in 108 patients is described. The efficacy of this procedure in relieving tamponade resulting from a variety of diseases is demonstrated. Blood clot in the pericardium probably constitutes a contraindication to catheter drainage.     

腹腔镜穿刺置管引流术与腹腔镜切开置管引流术治疗肝脓肿患者疗效观察

目的 比较腹腔镜穿刺置管引流术与腹腔镜切开置管引流术治疗肝脓肿患者的疗效。方法 2019年1月～2020年12月我院收治的63例肝脓肿患者,其中32例观察组接受腹腔镜穿刺置管引流术,另31例对照组接受腹腔镜切开置管引流术,术后随访3个月。采用ELISA法检测血清白细胞介素6(IL-6),采用胶体金法检测血清降钙素原(PCT)水平,采用双抗体夹心法检测血清C反应蛋白(CRP)水平。结果 本研究观察组治愈率为96.9%,与对照组100.0%比,无显著性差异(P>0.05);观察组住院日和住院费用分别为(14.2±2.3)d和(1.3±0.2)万元,均显著少于或短于对照组【分别为(16.1±2.5)d和(1.6±0.3)万元,P<0.05】,观察组体温正常时间和脓腔消失时间分别为(2.3±0.4)d和(10.3±1.5)d,均显著长于对照组【分别为(1.7±0.4)d和(8.4±1.2)d,P<0.05】;在术前和术后7 d,观察组血清ALT、ALB、AST、GGT及CRP、PCT、IL-6水平和WBC计数比较均无显著性差异(P>0.05)。结论 腹腔镜穿刺置管引流术...     

Percutaneous puncture and drainage of pancreatic pseudocysts

A total of 63 patients with cystic pancreatic lesions (60 pseudocysts, 3 true cysts) underwent percutaneous therapeutic procedures with ultrasound guidance. Repeated needle aspirations were performed in 50 patients, 13 underwent transabdominal catheter drainage. Complete resolution of the cystic lesion was obtained in 37 (59%) patients overall, while 41% required further therapy. Thirty seven (62%) of the 60 pancreatic pseudocysts were successfully drained by percutaneous procedures, in 23 (38%) fluid collections recurred. Complications of the drainage procedures occurred in two patients (3.2%). Considering these results, ultrasound guided needle aspiration and catheter drainage of pancreatic pseudocysts have proved to be of value for both nonsurgical temporary and definitive treatment.     

Reconstruction of the pericardial sac with glutaraldehyde-preserved bovine pericardium

Complete closure of the pericardial sac after open-heart surgery is thought to be a help in avoiding some postoperative complications and in facilitating reoperation. Since 1977, sixty-six patients who were subjected to open-heart surgery had glutaraldehyde stabilized xenogeneic bovine pericardial patches inserted to achieve closure of their own pericardial sacs. There were no hemodynamic problems related to the implantation of these patches. All 60 surviving patients were clinically well during a follow-up of 145 patient-years. Reoperation was undertaken in three patients 2(1/2), 3, and 7 years after the initial operation. The presence of the pericardial patch greatly facilitated the reopening of the chest because it prevented the formation of adhesions between the patch and the epicardium. Histologically, the implanted pericardium consisted of laminae of collagen fibrils containing evenly dispersed fibrocyte nuclei and parallel runs of fairly wide, separated elastic fibrils. There was no evidence of immune reaction. On the basis of our findings that there was no host reaction or complications after its use, glutaraldehyde stabilized xenogeneic bovine pericardium appears to be the material of choice for patch closure of the pericardium when primary closure alone is not feasible.     

持续性心包引流合并症的探讨

目的 持续性心包穿刺引流是治疗大量心包积液和心包填塞的常用方法,本文旨在探讨心包穿刺引流的合并症。方法 本文对5例发生了心包穿刺引流合并症的住院患者进行分析。结果 在5例合并症中,有2例因导管前端刺激发生神经介导性晕厥,1例发生急性右心室扩张并死亡,1例发生心包积液经导管管侧孔漏入左侧胸腔,1例出现急性肺水肿和心包积液经穿刺处漏入皮下组织。结论 应充分认识持续心包引流所引起的血流动力学改变,对危重患者应行床旁血流动力学监测。同时应注意引流导管本身对患者可能造成的损伤。     

Clinical definition of the axillary vein and experience with blind axillary puncture

The prevalence of congenital anomalies of the coronary arteries (CAAs) is reported to be approximately 0.2-1.4% of the general population. Of them, The double right coronary artery (RCA) is one of the rarest coronary anomalies. Nonetheless, there is no consensus of the definition of a double RCA until now. Several concepts have been proposed in order to define what is and is not a double RCA. So far, it was been reported 37 times and in 44 cases after a comprehensive literature search through the PubMed database, using the keywords “double right coronary artery,” “duplicated right coronary artery,” “dual right coronary artery” and “split right coronary artery.” Most of the published articles (28 of 37 articles) used the name “double right coronary artery.” Nevertheless, some investigators contended that a split RCA is anatomically the same anomaly as the improperly named “double right coronary artery”. The debate between those who favor “double RCA” and those who favor “split RCA” indicate the need for a consensus regarding the nomenclature as well diagnostic criteria of such coronary anomalies. It is the time we need to reach a consensus of the nomenclature of this congenital coronary anomaly.