Diagnosis and treatment of acute cardiac tamponade by the subxiphoid approach.
Diagnosis and treatment of acute cardiac tamponade by the subxiphoid approach.
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剑突下入路急性心包填塞的诊断和治疗。
DOI：
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发表时间：
1983
期刊：
影响因子：
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通讯作者：
M. Hoshiai
中科院分区：
文献类型：
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作者：
A. Shohtsu;S. Koide;S. Kawada;H. Inoue;J. Ogawa;T. Fukuda;S. Inamura;M. Hoshiai
急诊心脏手术治疗急性心包填塞18例，其中转移性癌11例，特发性心包炎4例，其他原因3例。在大多数情况下，主诉是呼吸困难。在许多情况下，正面胸部X光片的心脏轮廓显示出放在桌子上的装满水的冰袋的形状。心电图显示大约一半的患者有低电压和平坦的T波。M型超声心动图无回声间隙大于或等于1 cm者，心包积液量平均为850ml，小于1 cm者平均引流量为557ml，恶性心包积液CT值为9~40，特发性心包炎CT值为20~22。一般情况下，几乎所有急性心包填塞的患者都进行了心包穿刺术，但如果引流不充分，则在局部麻醉下进行剑突下心包窗手术。手术创伤小，手术效果良好。在手术中，我们切除了一段2×2厘米的心包。由于两名恶性心包积液患者术后出现再积聚，因此考虑在将来切除一段4×4厘米的心包积液。
Emergency cardiac surgery has been performed on 18 cases of acute cardiac tamponade whose etiologies were as follows: 11 cases of metastatic carcinoma, four cases of idiopathic pericarditis and three with other causes. In most cases, the chief complaint was dyspnea. In many cases, the cardiac silhouette of frontal chest X-ray films showed the shape of a water-filled ice-bag placed on a table. The electrocardiogram showed a low voltage and a flat T-wave in approximately half of the patients. In cases of an echo-free space 1 cm or larger on the M-mode echocardiogram, the average amount of pericardial fluid drained was 850 ml and in those in which the space was less than 1 cm, the average drained was 557 ml. The CT values were 9-40 for patients with malignant pericardial effusion and 20-22 for cases of idiopathic pericarditis. In general, pericardiocentesis was performed in almost all the patients with acute tamponade, but if the drainage was inadequate, the subxiphoid pericardial window procedure was performed under local anesthesia. Surgical invasion in this technique was minimal and the operative results proved effective. For the operation, we resected a 2 X 2 cm pericardial segment. Since two of the patients with malignant pericardial effusion developed postoperative reaccumulation, resection of a 4 X 4 cm segment in the future has been contemplated.