心包穿刺术

定义

心包穿刺术 is a procedure that uses a needle to remove fluid from the pericardial sac. This is the tissue that surrounds the heart.

选择的名字

Pericardial tap; Percutaneous pericardiocentesis; 心包炎 - pericardiocentesis; Pericardial effusion - pericardiocentesis

How the Test is Performed

The procedure is most often done in a special procedure room, such as a cardiac catheterization laboratory. It may also be done at a patient's hospital bedside. A health care provider will put an IV into your arm in case fluids or medicines need to be given through a vein. 例如, you may be given medicines if your heartbeat slows or your blood pressure drops during the procedure.

The provider will clean an area just below or next to the breastbone or below the left nipple. Numbing medicine (anesthetic) will be applied to the area.

The doctor will then insert a needle and guide it into tissue that surrounds the heart. 通常, 超声心动图 (ultrasound) is used to help the doctor see the needle and any fluid drainage. An electrocardiogram (心电图) and moving x-ray images (fluoroscopy) may also be used to help with positioning.

Once the needle has reached the correct area, it is removed and replaced with a tube called a catheter. Fluid drains through this tube into containers. 大多数时候, the pericardial catheter is left in place so draining may continue for several hours.

Surgical drainage may be needed if the problem is hard to correct or comes back. This is a more invasive procedure in which the pericardium is drained into the chest (pleural) cavity. Alternatively, the fluid may be drained into the peritoneal cavity, but this is less common. This procedure may need to be done under general anesthesia.

How to Prepare for the Test

You may not be able to eat or drink for 6 hours before the test. You must sign a consent form.

考试的感觉如何

You may feel pressure as the needle enters. 有些人有 胸部疼痛, which may require pain medicine.

Why the Test is Performed

This test may be done to remove and examine fluid that is pressing on the heart. It is most often done to find the cause of a chronic or recurrent 心包积液.

It may also be done to treat 心脏压塞, which is a life-threatening condition.

正常的结果

There is normally a small amount of clear, straw-colored fluid in the pericardial space.

What Abnormal Results Mean

Abnormal findings may indicate the cause of pericardial fluid accumulation, such as:

• 癌症
• 心脏穿孔
• 心脏创伤
• Congestive heart failure
• 心包炎
• 肾功能衰竭
• 感染
• Rupture of a ventricular 动脉瘤

风险

风险可能包括:

• 出血
• 肺功能衰竭,
• 心脏病
• 感染 (pericarditis)
• 心律不齐(心律失常)
• Puncture of the heart muscle, coronary artery, lung, liver, or stomach
• Pneumopericardium (air in the pericardial sac)

参考文献

嘿，BD，哦，JK. 心包疾病. In: Goldman L, Schafer AI, eds. Goldman-Cecil医学. 26日艾德. Philadelphia, PA: Elsevier; 2020:chap 68.

Lewinter MM, Cremer PC, Klein AL. 心包疾病. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12日艾德. Philadelphia, PA: Elsevier; 2022:chap 86.

Mallemat HA, Tewelde SZ. 心包穿刺术. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7日艾德. Philadelphia, PA: Elsevier; 2019:chap 16.