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目的了解经皮冠状动脉介入治疗(PCI)中心包积液/心脏压塞发生率、发生的相关因素、处理以及预后,为PCI的正确操作及合理选用器械提供参考。方法分析了1246例PCI资料,包括住院病历、PCI操作记录、护理记录和影像学资料,判定心包积液/心脏压塞发生原因、时间、临床表现、处理方式和结果。结果共8例心包积液(064%)、3例心脏压塞(024%),其中10例(91%)在导管室确诊,1例(9%)延期发现。冠状动脉造影直接发现导引钢丝和/或球囊致冠状动脉穿孔9例(818%),其中球囊通过冠状动脉破口未扩张2例,球囊通过冠状动脉破口并扩张1例,冠状动脉穿孔多发生在慢性完全闭塞性病变(CTO);通过临床表现、超声心动图证实起搏电极导线致右心室穿孔2例(182%),均出现在心肌梗死后患者。球囊通过冠状动脉破口并扩张1例,发生迟发性心脏压塞,6h后急诊外科干预引流后治愈;右心室临时起搏电极导管穿破右心室2例,1例行心包穿刺术,另1例心包穿刺后留置猪尾导管引流2d成功治愈。结论冠状动脉及右心室穿孔是PCI并发心包积液/心脏压塞的主要原因,前者多发生在CTO患者,后者易出现于心肌梗死后患者。正确的操作方法及合理的器械选择可能减少此并发症的发生。冠状动脉穿孔较心室穿孔易于诊断,心包积液/心脏压塞多数能在导管室早期发现,并能得以合理的
Objective To investigate the incidence of central pericardial effusion, incidence of related factors, treatment and prognosis in percutaneous coronary intervention (PCI), so as to provide reference for the correct operation of PCI and the rational selection of instruments. Methods The data of 1246 patients with PCI were analyzed, including in-patient records, PCI operation records, nursing records and imaging data to determine the causes, time, clinical manifestations, treatment methods and results of pericardial effusion / cardiac tamponade. Results A total of 8 cases of pericardial effusion (064%) and 3 cases of cardiac tamponade (024%) were diagnosed in 10 cases (91%). One case (9%) was delayed. Coronary angiography directly found 9 cases (818%) of coronary artery perforation caused by guide wire and / or balloon. The balloon did not expand in 2 cases through the coronary artery, the balloon broke through the coronary artery and expanded in 1 case, Arteriolar perforation occurred mostly in patients with chronic total occlusive disease (CTO); 2 cases (182%) of right ventricular perforation were confirmed by echocardiography through the clinical manifestations, both of which occurred in patients with myocardial infarction. Balloon through the coronary artery break and expansion in 1 case, delayed cardiac tamponade, 6h emergency surgical intervention after drainage and cure; right ventricular temporary pacing catheter puncture in 2 cases of right ventricle, 1 case of pericardiocentesis, Another case of pericardiocentesis after pigtail catheter indwelling 2d successfully cured. Conclusions Coronary artery and right ventricular perforation are the main causes of pericardial effusion and cardiac tamponade in PCI. The former mostly occurs in patients with CTO, the latter in patients with myocardial infarction. The correct method of operation and reasonable choice of instruments may reduce the incidence of this complication. Coronary perforation is easier to diagnose than perforation of the ventricle, and most pericardial effusion / cardiac tamponade can be found early in the ductal compartment and can be reasonably