Cardiac Tamponade - Causes,症状,处理


Cardiac tamponade is a life-threatening condition in which either a typical心包积液(也就是说,the accumulation of an abnormal amount of fluid in the pericardial sac) or bleeding into the pericardial sac,disrupts the normal function of the heart.心包填塞可以是急性的,也可以是逐渐发展的。在任何一种情况下,symptoms are usually quite striking,and the resolution of symptoms requires the expeditious removal of the excess fluid from the pericardial sac.

How Is Cardiac Tamponade Produced?

心包囊内压力升高时发生心包填塞,caused by the excess fluid,becomes sufficient to restrict the filling of the heart duringdiastole.因为心脏不能完全填满,每次心跳排出的血液更少,心脏必须更努力地工作来满足身体的需要。此外,the blood trying to enter the heart tends to back up,producing congestion in the lungs and veins.

The amount of pericardial fluid which is necessary to produce tamponade depends on to a great extent on how rapidly the fluid has accumulated.If pericardial fluid increases rapidly,心包没有时间“舒展”,即使有少量液体,心包空间内的压力也会大大增加。另一方面,如果心包积液逐渐积聚(比如,在几天或几周内,the pericardium has time to stretch out to accommodate the extra fluid.In this case,在心包积液变大之前,心包间隙内的压力可能不会显著增加。to the point at which the pericardium is incapable of stretching any further.


心包积液可由心包积液引起。These include:


症状的类型和严重程度取决于填塞物是迅速发展还是逐渐发展。急性填塞最典型的是胸部创伤。心脏手术或其他侵入性心脏手术,such as心导管插入术,or byaortic dissection.在所有这些条件下,blood can fill the pericardial sac in a matter of seconds or minutes,producing rapid and severe cardiac compromise.因为过量的液体blood) in the pericardial sac accumulates rapidly in these conditions,tamponade can develop even with a relatively small amount of pericardial fluid.Symptoms are immediately striking and severe.胸痛,严重的呼吸急促,和tachycardiapalpitationsare common.Very low blood pressure may occur,伴随着异常凉爽的皮肤,皮肤发蓝变色,尿量减少。

Acute tamponade is a medical emergency,and rapid death is likely if it is not treated quickly.

非外伤性心包填塞,医疗程序,or aortic dissection tends to develop somewhat more gradually,usually over days or weeks.The pleural effusions in these "sub-acute" cases tend to be much larger than in acute cases since the pericardium usually has time to stretch out to accommodate the more gradual fluid accumulation.Symptoms are also less dramatic.Patients with sub-acute tamponade generally experience chest fullness or discomfort,easy fatigue-ability,shortness of breath with minimal activity,和edema在腿和脚上。但是,尽管症状的发展可能不如急性填塞时那么明显,它们最终会变得相当严重。这种逐渐形成的心包填塞也可能致命,而且迅速的治疗仍然是必要的。

How Is Cardiac Tamponade Diagnosed?

医生通常会通过倾听病人的症状来怀疑心脏填塞。by the clinical circumstances (such as the suspected presence of any of the medical conditions known to cause tamponade),通过体检。通过胸部X光和electrocardiogram.Once this condition is suspected,诊断可以很容易地通过echocardiogram.


心包填塞的治疗是清除心包囊中多余的心包液。The removal of fluid relieves the pressure within the pericardial sac and allows the heart to resume its normal function.

心包液的清除通常是通过pericardiocentesis也就是说,draining the fluid through a flexible catheter inserted into the pericardial space.交替地,液体清除可以通过外科引流程序完成。手术引流通常在以下情况下进行:除了排出液体外,出于诊断原因,需要对心包进行活检。If the pericardial effusion comes back after it has been drained,一心包切除术(手术切除心包)可能成为防止进一步复发的必要手段。

只要能迅速诊断和解决,cardiac tamponade virtually always can be treated effectively,and the long-term outcome usually depends mainly on the nature and the severity of the underlying medical cause.

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