21例心内直视术后急性心包填塞的临床分析

目的:分析21例心内直视术后急性心包填塞的临床特点,探讨其发生原因、预防、救治及其二次开胸的早期指征。方法:对1991年1月-2005年12月心内直视术(共1096例)后21例急性心包填塞二次开胸(发生率1．92％)病例进行总结分析。结果:急性心包填塞患者经二次剖胸解除心包填塞后17例痊愈出院,4例死亡,二次剖胸手术死亡率为19．05％。二次剖胸手术者所患疾病包括先天性心脏病6例,瓣膜病13例,大血管手术1例,心脏移植1例。结论:减少心内直视术后出血、渗血是避免术后发生急性心包填塞的关键,早期诊断并尽早行二次剖胸手术可明显降低围手术期死亡率。

Clinical Analysis on 21 Cases with Acute Cardiac Tamponade after Open Heart Surgery

Objective:The main purpose of this study was to evaluate the prophylaxis, management and criteria for early re-exploration in patients with acute tamponade after cardiac surgery. Methods: In a retroploration procedure-matched study, 21 of 1096 patients of cardiac surgery during 1991. 1 to 2005. 12 underwent re-exploration after acute cardiac tamponade (1. 92%). Results: Seventeen patients were fully recovered from re-exploration and 3 patients died. Conclusion: Early surgical treatment should be awared and taken promply. Decreasing bleeding is the key to avoid acute cardiac tanponade after open heart surgery. Diagnosis and re-exploration should be done as early as possible to decrease mortality rate during peri-operation.