冠状动脉支架植入术后心包积血:临床观察及文献复习

Q4 Medicine Meditsinskiy Sovet Pub Date : 2023-10-21 DOI:10.21518/ms2023-349
N. Yu. Semigolovskii, I. S. Simutis, S. O. Mazurenko, E. M. Nikolskaya, M. O. Mazurenko
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引用次数: 0

摘要

目前,全世界每年至少有500万冠状动脉疾病患者接受经皮冠状动脉介入治疗并植入支架,其中俄罗斯超过20万。冠状动脉的剥离和穿孔是非常罕见的,但它们是非常危险的并发症,可导致心包积血合并心包填塞、心源性休克、心肌梗死、各种心律失常和死亡。根据不同作者的说法,心脏填塞在介入心脏病学中的频率从0.1%到3.0%不等。文献中引用的死亡频率也有很大差异(0-20-40%)。与此同时,没有专门的登记册来积累具体国家和整个世界的冠状动脉穿孔数据。遗憾的是,目前仍没有明确的识别高危患者的算法,其密集随访的必要时机尚不明确,在保守、血管外科和手术治疗策略之间选择的标准尚未明确。除了对这一主题的最新文献资料进行综述外,本文还介绍了3例老年患者经皮介入治疗后不同时间心包积血的临床病例,这些病例有不同的症状和结果。观察结果说明了症状的可变性、诊断和治疗的复杂性,并且还涉及到不同领域专家(x射线血管外科医生、心脏外科医生、重症监护专家、心脏病专家和功能诊断医生)参与的多学科方法的问题。
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Hemopericardium after coronary artery stenting: clinical observations and literature review
Currently, at least 5,000,000 patients with coronary artery disease undergo percutaneous coronary interventions with stent implantation every year in the world, and more than 200,000 in Russia. Dissection and perforation of the coronary artery are quite rare, but they are very dangerous complications leading to the development of hemopericardium with cardiac tamponade, cardiogenic shock, myocardial infarction, various arrhythmias and death. The frequency of cardiac tamponade in interventional cardiology, according to various authors, ranges from 0.1 to 3.0% of all interventions. The frequency of deaths cited in the literature also varies greatly (0–20–40%). At the same time, there are no special registers that accumulate data on coronary artery perforations in concrete countries and in the world as a whole. Unfortunately, today, there is still no clear algorithm for identifying high-risk patients, the necessary timing of their intensive follow-up is not clear, and the criteria for choosing between conservative, angiosurgical and operative treatment tactics are not defined. In addition to a literary review of recent sources on this topic, the article presents 3 clinical cases of hemopericardium development in elderly patients at different times after percutaneous interventions, with different symptoms and with different outcomes. The observations illustrate the variability of symptoms, the complexity of diagnosis and treatment, and also touch upon the issues of a multidisciplinary approach with the participation of specialists of different profiles (X-ray angiosurgeons, cardiac surgeons, intensive care specialists, cardiologists and doctors of functional diagnostics).
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来源期刊
Meditsinskiy Sovet
Meditsinskiy Sovet Medicine-Medicine (all)
CiteScore
0.70
自引率
0.00%
发文量
418
审稿时长
6 weeks
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