CAJ | 학술논문

目的：探讨急诊塞尔丁格（Seldinger）法心包穿刺置管术的疗效及安全性。方法急诊大量心包积液合并有填塞症状的患者23例，按急诊来诊顺序分为常规穿刺组10例、塞尔丁格法组13例，塞尔丁格法组采用塞尔丁格法心包穿刺置管引流术，常规穿刺组采用传统的心包穿刺抽液术治疗，比较两组患者治疗前后症状变化，治疗后超声下心包内积液厚度变化情况，以及手术并发症。结果塞尔丁格法组患者均只行1次穿刺引流术，引流液总量约800～1500ml；常规穿刺组行2～3次穿刺抽液，抽液总量约700～1200ml。塞尔丁格法组患者症状缓解较明显。但两组患者引流术后的生理参数（心率、脉压差、呼吸频率和血氧饱和度）变化无统计学意义。治疗后复查超声示塞尔丁格法组心包内残留液体量少于常规穿刺组（P ＜0.05）。常规穿刺组术中出现室性早搏3例，塞尔丁格法组未见手术并发症。结论采用塞尔丁格法穿刺置管引流术可有效彻底引流心包内积液，安全性好，值得临床推广应用。
목적：탐토급진새이정격（Seldinger）법심포천자치관술적료효급안전성。방법급진대량심포적액합병유전새증상적환자23례，안급진래진순서분위상규천자조10례、새이정격법조13례，새이정격법조채용새이정격법심포천자치관인류술，상규천자조채용전통적심포천자추액술치료，비교량조환자치료전후증상변화，치료후초성하심포내적액후도변화정황，이급수술병발증。결과새이정격법조환자균지행1차천자인류술，인류액총량약800～1500ml；상규천자조행2～3차천자추액，추액총량약700～1200ml。새이정격법조환자증상완해교명현。단량조환자인류술후적생리삼수（심솔、맥압차、호흡빈솔화혈양포화도）변화무통계학의의。치료후복사초성시새이정격법조심포내잔류액체량소우상규천자조（P ＜0.05）。상규천자조술중출현실성조박3례，새이정격법조미견수술병발증。결론채용새이정격법천자치관인류술가유효철저인류심포내적액，안전성호，치득림상추엄응용。
Objective To investigative the effectiveness and safety of emergency pericardiocentesis with Seldinger puncture and tube drainage technique for pericardial effusion. Methods 23 emergency patients with large amount of pericardi-al effusion and tamponade symptom were included.In Seldinger's group,1 3 patients were performed with emergency pericardio-centesis with Seldinger puncture and tube drainage technique.In traditional pericardiocentesis (traditional)group,1 0 patients were performed with traditional pericardiocentesis drainage technique.The symptoms of patients,variation in thickness of pericar-dial effusion by ultrasound and complication were compared between the two groups. Results In Seldinger's group,patients were performed with puncture only one time,the gross drainage liquid were about 800 ~1 500ml.In the traditional group,pa-tients were performed with puncture 2 ~3 times,the gross infusion were about 700 ~1 200ml.The tamponed symptom were allevi-ated in the two groups.The changes of physiological parameter (heart rate,pulse pressure difference,respiratory rate,oxyhemo-globin saturation)after operations between the two groups had no statistical difference (P >0.05).The residual liquid checked by ultrasound in the Seldinger's group were less than the traditional group (P <0.05).The Seldinger's group had less complica-tion too. Conclusion Pericardiocentesis with Seldinger puncture and tube drainage technique for pericardial effusion can thor-ough drain liquid,it is worthy of clinical popularization and application for the effect and safety.