从心导管实验室到心胸外科手术室的 PTCA 术后心脏填塞的麻醉管理

Ameerunnisha Begum, Niranjni Sivadoss, Lakshmi Ramakrishnan
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摘要

心脏填塞是一种医学急症,其特点是心包囊积液,对心脏产生压力,影响其有效泵血的能力。造成这种情况的原因有很多,包括外伤、感染、恶性肿瘤或经皮冠状动脉介入治疗(PCI)(如经皮冠状动脉腔内成形术(PTCA))等医疗程序的并发症。麻醉科医生作为导管室的围手术期医生和重症监护室的重症监护医生,在及时识别和干预方面发挥着关键作用,这对于防止血流动力学衰竭和改善患者预后至关重要。在本病例中,一名 50 多岁的女性患者既往有 PCI 病史,在接受 PTCA 术后不久出现心脏填塞。尽管导管室立即尝试稳定病情,但患者的病情迅速恶化,不得不进行紧急心包穿刺,随后进行开胸手术以明确治疗。本病例的成功结果强调了早期识别、快速干预和多学科方法在处理 PTCA 术后心脏填塞的重要性。
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Anaesthetic management of post-PTCA cardiac tamponade from cath lab to cardiothoracic operating theater
Cardiac tamponade is a medical emergency characterized by the accumulation of fluid in the pericardial sac, exerting pressure on the heart and impairing its ability to pump blood effectively. This condition can result from various causes, including trauma, infection, malignancy, or complications of medical procedures such as percutaneous coronary interventions (PCI) like percutaneous transluminal coronary angioplasty (PTCA). The anaesthesiologists play a pivotal role as peri operative physicians in the catheterization laboratory and intensivists in the ICU in prompt recognition and intervention which is crucial to prevent hemodynamic collapse and improve patient outcomes. In this case, a female in her fifties with a history of previous PCI developed cardiac tamponade shortly after undergoing PTCA. Despite immediate stabilization attempts in the catheterization laboratory, the patient's condition deteriorated rapidly, necessitating emergency pericardiocentesis and subsequent thoracotomy for definitive management. The successful outcome of this case underscores the importance of early recognition, rapid intervention, and a multidisciplinary approach in managing cardiac tamponade post-PTCA.
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