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題 名 | Sudden Death Shortly after Successful Pericardiocentesis in Cardiac Tamponade Complicating in Aortic Dissection--A Case Report=主動脈剝離併發心包膜填塞成功心包膜抽液後立即死亡--一病例報告 |
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作 者 | 李茂琦; 曾炳憲; 楊世平; 賴文源; | 書刊名 | Acta Cardiologica Sinica |
卷 期 | 14:3 民87.07-09 |
頁 次 | 頁149-153 |
分類號 | 416.263 |
關鍵詞 | 主動脈剝離; 心包膜填塞; 心包膜抽液; Aortic dissection; Cardiac tamponade; Pericardiocentesis; |
語 文 | 英文(English) |
中文摘要 | 背景:心包膜填塞常併發於急性近端主動脈剝離,同時也是主動脈剝離最主要死因之一。然而緊急心包膜抽液計於因主動脈剝離併發的心包膜積血似乎是有害的。對於一位主動脈剝離合併心包膜填塞造成血流循環潰縮的病患我們應該如何處理。 方法與結果:一位五十四歲男性A型主動脈剝離病患合併嚴重低血壓和氣喘。心臟超音波檢查發現顯著心包膜積液合併心包膜填塞。為了穩定病患抽取150mL心包膜積血後,心搏速率立刻由每分鐘156次降至80次,同時血壓由86/50mmHg回升至124/80mmHg。再度心臟超音波檢查顯示僅剩下微量心包膜積液,同時病患覺得症狀改善。然而在緊急心包膜抽液後不久發生突發性每分鐘30次心搏過緩,同時無法量得週邊動脈脈搏。此時心臟超音波再度發現大量心包膜積液,造成致死性心包膜填塞。 結論:心包膜抽液對於治療主動脈剝離併發心包膜積血可能害處多於益處。因為此病例復發心包膜填塞太突然且病患迅速死亡,我們來不及測量心臟腔室,肺部血管及主動脈壓力。 依據文獻理論上經由心包膜抽液,它可以影響主動脈內壓力和心包膜內壓力,導致復發性心包膜填塞。所以心包膜抽液可能是有害的。然而在某些情況下維持基本的腦部和維生器官血液灌流它可能仍然是有價值的。 |
英文摘要 | Background. Cardiac tamponade frequently complicates acute proximal aortic dissection and is one of the common causes of death from that procedure. However, emergency pericardiocentesis seems a harmful procedure to use in the management of hemopericardium of aortic dissection. What should be done in a patient with hemodynamic collapse because of cardiac tamponade in acute aortic dissection. Methods and Results. A 54-year-old male with acute type A aortic dissection manifested with hypotension and shortness of breath. Echocardiogram revealed a large amount of pericardial effusion with signs of cardiac tamponade. The patient's hemodynamic status was stabilized as reflected in the responses of heart rate (decrease from 156/min to 80/min) and blood pressure (increase from 86/50 mmHg to 124/80 mmHg), after 150 ml bloody pericardial effusion was aspirated. The follow-up echocardiogram revealed a minimal amount of pericardial effusion, and the patient felt well. Unfortunately, sudden onset of bradycardia (30/min) associated with loss of peripheral arterial pulsation occured shortly after emergency pericardiocentesis. At this time, the echocardiogram showed a massive amount of pericardial effusion, which led to fatal cardiac tamponade. Conclusion. Pericardiocentesis may be harmful rather than beneficial in the treatment of cardiac tamponade complicated by aortic dissection. Because the recurrent cardiac tamponade happened very rapidly and the patient died suddenly, firmly hemodynamic measurements were not possible. When the pericardial effusion was aspirated, the intraaortic pressure and intrapericardial pressure may have theoretically changed, leading to recurrence of cardiac tamponade. It seems that pericardiocentesis may have been harmful in this case. However, it could be valuable in some instances to stabilize a patients hemodynamic status, sufficient to maintain perfusion of vital organs. |
本系統中英文摘要資訊取自各篇刊載內容。