薛玉生 郑强荪 杜日映 王毅 罗景兰 第四军医大学唐都医院心内科，陕西西安 710038 中国心脏起搏与心电生理杂志 2000 0 14 2


    关键词：心包填塞，急性；导管消融，射频电流；心动过速；心包穿刺引流 期刊 zgxzqbyxdslzz 0 139-141 诊疗经验介绍 fur -->


    

摘要 报告938例各种心动过速射频消融术中遇到的12例急性心包填塞患者。引起心包填塞的原因有：①放置电极导管至右心耳时用力过大致右心耳损伤(2例)；②放置电极导管至冠状静脉窦(CS)时，因导管不易进入远端而用力过大致CS损伤(3例)；③心内电除颤时采用高位右房和CS电极作回路，致CS损伤(1例)；④房间隔穿刺系统向上滑动穿破右房(3例)和左房(2例)；⑤放置左上肺静脉标测电极时导管误入左心耳致其穿孔(1例)。10例急性心包填塞出现于术中，另2例术后发生。12例患者经紧急心包穿刺引流均成功治愈，无1例需外科急诊手术。了解这些心包填塞的原因有助于采取有效措施预防其发生。心包穿刺引流是解除心包填塞简单、安全、有效的方法。

    中图分类号 R541.7 R542.1⁺ 2 文献标识码 A

    文章编号 1007—2659(2000)02—0139—03

The Causes,Manifestations and Management of Acute Cardiac Tamponade in Radiofrequency Catheter Ablation of Tachycardias.

XUE Yu-sheng,ZHENG Qiang-sun,DU Ri-ying,et al.

12 cases of acute cardiac tamponade encountered in radiofrequency catheter ablation of 938 cases of different tachycardias were reported. The causes were right auricle injury by violently placing a electric catheter to it (n=2),coronary sinus (CS)injury by violently placing a electric catheter to distal CS (n=3) and by intracardiac electric defibrillation using electric catheter electrodes of high right atrium and CS as current loop(n=1),perforations of right atrial wall (n=3) and left atrial wall(n=2) by sliding up of the transseptal set,and perforation of left auricle by misplacing the mapping catheter of left superior pulmonary vein to it (n=1). 10 cases of acute tamponade occurred during operation, and 2 after operation.12 patients were treated successfully with urgent pericardiocentesis, and no patients required emergency surgery. Understanding these causes is helpful for taking effective strategies to prevent the occurence of cardiac tamponade. Pericardiocentesis is a simple, safe and effective therapy for acute cardiac tamponade.

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