一次性多功能引流袋与自制引流瓶在恶性心包积液治疗中的对比研究
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摘要
心包积液是由多种病因引起的一种临床表现。随着诊疗技术的不断提高，导致肿瘤的危险因素增加，肿瘤的发病率及检出率也不断提高，以致恶性心包积液所占比例呈上升趋势。当心包内快速积聚大量心包积液时，可导致心包填塞危及生命，最直接、有效的治疗措施为心包减压术，其中中心静脉导管心包穿刺置管引流术因其简洁、安全等优势被广泛应用。目前，临床上缺少与中心静脉导管相配套的体液引流收集装置，临床医师通常会利用手边材料自制心包积液引流收集装置如引流瓶、引流袋，这种自制的体液引流收集装置存在制作复杂、耗时长、易脱落、易污染、使用不方便和舒适性差等问题。我科自行研发的一次性多功能引流袋（专利号：ZL200920255142.7）使上述问题得到解决，在心包积液引流收集过程中的安全性及有效性得到显著提高。
目的：探讨一次性多功能引流袋连接中心静脉导管对恶性心包积液进行引流，与传统的自制引流瓶对比研究，评价一次性多功能引流袋在临床应用中的安全性及有效性。
方法：本实验收集2010-9至2011-10就诊于河北医科大学第四医院呼吸科住院患者40例，均经心包积液脱落细胞学检查找到癌细胞而确诊为恶性心包积液，其中女性11例，男性29例；年龄36~72岁，平均年龄56.5±9.4岁；均经超声证实为中-大量心包积液；排除主动脉夹层合并心包积液者，不能纠正的凝血性疾病患者，正在行抗凝治疗的，有出血倾向或血小板低于50×10~9/L的心包积液，位于后壁或局限的心包积液，漏出液以及心包感染所致的非肿瘤性渗出液，肝功能衰竭、肾功能衰竭等疾病患者。按患者住院顺序随机分为2组，实验组及对照组。实验组：于超声定位下，采用Seldinger技术放入ARROW中心静脉导管行心包穿刺置管引流术，连接一次性多功能引流袋引流和收集心包积液，整个过程无菌操作。采用持续引流方法，引流速度为5-10ml/min，逐渐将心包积液引流干净，避免短时间大量引流造成急性右心扩张等并发症，每次心包内注入顺铂20mg和白介素-Ⅱ40万单位（顺铂总量不超过160mg），夹毕引流管48～72小时。之后再次持续引流心包积液直至干净为止，重复上述治疗。如24小时引流量小于25ml，并经B超确定为心包积液量极少或消失后，可拔出引流管。对照组：于超声定位下采用Seldinger技术放入ARROW中心静脉导管行心包穿刺置管引流术，连接自制引流瓶引流和收集心包积液。严格遵守无菌操作，心包引流和注药过程与实验组相同。多功能引流袋和自制引流瓶每8天更换。
比较对照两组患者心包积液引流治疗过程中，多功能引流袋和自制引流瓶（引流袋/瓶）连接管脱落、堵塞情况和疏通结果，恶性心包积液治疗效果，气体心包返流发生率，引流袋/瓶内液体污染率，引流袋/瓶安装或更换时间和患者满意程度。
结果：
1引流管脱落率、堵塞率、疏通成功率：实验组20例心包积液患者中，引流管接头脱落发生0例，发生率为0%，引流管堵塞发生3例，全部疏通成功，堵塞率及疏通成功率分别为15%和100%；对照组20例心包积液患者中，引流管接头脱落发生5例，发生率为25%，引流管堵塞发生10例，疏通成功2例，堵塞率及疏通成功率分别为50%和20%，各项指标均为P＜0.05，两组比较有显著统计学差异，实验组引流管接头脱落率、堵塞率低于对照组，疏通成功率高于对照组
2治疗有效率：实验组20例心包积液患者中，完全缓解15例，好转4例，总有效19例，有效率为95%；对照组20例心包积液患者中，完全缓解14例，好转4例，总有效18例，有效率为90%，P＞0.05，两组比较无显著统计学差异。
3气体返流发生率：实验组20例心包积液患者中，气体返流发生1例，发生率为5%，返流原因为中心静脉导管体外段发生断裂；对照组20例心包积液患者中，气体返流发生7例，发生率为35%，均为医源性气体返流，原因为引流管过滤膜乳头端与中心静脉导管连接脱落和引流瓶内气体反流，P＜0.05，两组有显著统计学差异，实验组气体返流发生率明显低于对照组。
4引流袋（瓶）内液体污染率：实验组20例心包积液患者中，每8天抽取引流袋内积液一次，送检细菌学培养，共32次，均细菌培养阴性，引流袋内液体污染率为0%；对照组20例心包积液患者中，送检细菌学培养39次，引流瓶内液体培养阳性6例，铜绿假单胞菌3例，金葡菌2例，大肠杆菌1例，引流瓶内液体污染率为15%，P＜0.05，两组有显著统计学差异，实验组引流袋内液体细菌污染率明显低于对照组。
5引流袋（瓶）安装或更换时间：实验组20例心包积液患者中，共接受引流袋安装和更换47次，每次安装或更换时间16～35秒，平均为48.75±10.84秒；对照组20例心包积液患者中，共接受引流瓶安装和更换49次，每次安装或更换时间180～420秒，平均为270.95±44.76秒，P＜0.001，两组比较有显著统计学差异，实验组安装及更换时间显著低于对照组。
6患者满意率：实验组20例心包积液患者中，对引流袋非常满意14例，满意5例，满意率95%；对照组20例心包积液患者中，对引流瓶非常满意3例，满意4例，满意率35%；P＜0.05，两组比较有显著统计学差异，实验组患者满意率明显高于对照组。
结论：
在恶性心包积液治疗过程中，引流袋引流管脱落率、堵塞率、安装或更换时间、气体返流发生率均低于自制引流瓶；疏通成功率及患者满意程度高于自制引流瓶；引流袋内液体污染发生率低于自制引流瓶。证实一次性多功能引流袋临床应用的安全性及有效性。
本研究显示一次性多功能引流袋在恶性心包积液治疗过程中优于自制水封瓶，临床安装或更换方法简单，密闭性好，安全性高，佩戴美观舒适，引流效果确实，是恶性心包积液治疗中与中心静脉导管适配的专用引流袋，应当积极推广和应用。
Pericardial effusion is a clinical manifestation of a variety ofcauses. With the continuous improvement of the diagnosis and treatmenttechnology, the risk factors resulting in cancer increases, and the incidenceand detection rates of the tumor continue to increase, causing the proportion ofmalignant pericardial effusion is rising. The rapid accumulation of largepericardial effusion in the pericardium can lead to cardiac tamponade, whichwill threaten the life. The most direct, effective treatment is the pericardialdecompression. And the pericardiocentesis catheter drainage has been widelyused because of its simplicity and safety. Now the drainage devices matchingwith the central venous catheter are lack in clinical. The clinicians often usematerials produce drainage devices, such as self-made drainage bottles andordinary drainage bags. However, the production process is time consuming,easy dropping off, easy to pollution, inconvenient to use as well as otherproblems. The one-time disposable multifunctional drainage bag (Patent No.:ZL200,920,255,142.7) developed by our department has resolved the aboveproblems, and the safety and efficacy in the process of draining the pericardialeffusion has improved remarkably.
Objective: Through the comparative study on the traditional self-madedrainage bottle and the disposable multifunctional drainage bag connecting tothe central venous catheter to drain the pericardial effusion, evaluate the thesafety and efficacy of the disposable multifunctional drainage bag in theclinical application.
Methods: In this experiment, we collected40patients who werehospitalized for malignant pericardial effusion in the Department RespiratoryMedicine of The Forth Hospital of Hebei Medical University(2010.9~2011.3), including11women and29men, aged from36to72, mean age (56.5±9.4)years. They were diagnosed as malignant pericardial effusion by find cancercells in pericardial effusion cytology. They were all confirmed by ultrasoundwith moderate or severe pericardial effusion. The pericardial effusion patientswho with aortic dissection, clotting disorders not be corrected, the patientsunder anticoagulant therapy, the pericardial effusion patients with bleedingtendency or thrombocytopenia below50×10~9/L, the pericardial effusion inthe posterior wall or of the limitations, transudate, the non-neoplastic effusioncaused by pericardial infection and the patients with Liver function failure andrenal failure are ruled out. The patients were randomly divided into twogroups, experimental and control groups. Experimental group: Through theultrasound, use the Seldinger technique to position ARROWpericardiocentesis catheter drainage, and connect the bag to drain thepericardial effusion. The whole process is under aseptic manipulation. Wedrainaged the pericardial effusion continully, keeping the speed in5-10ml/min, to be avoided acute right heart dilation by drainage a lot ofpericardial effusion in a short-term. Inject20mg/time of cisplatin (the totalamount of cisplatin does not exceed120mg) and40million units/time ofinterleukin-II to the pericardium, and clip the drainage tube for48-72hours. Then, drain the pericardial effusion until no effusion left. If thedrainage volume in the24-hour is less than25ml and through theidentification of B-ultrasound, there is small amount of pericardial effusion,you can pull out the drainage tube. Control group: Through the B-ultrasound,use the Seldinger technique to position ARROW pericardiocentesis catheterdrainage, and connect the self-made bottle to drain the pericardial effusion.The aseptic manipulation will be carried out strictly, and the process and thepericardial injection are the same with those of the experimentalgroup. Charge the disposable multifunctional drainage bag or the self-madedrainage bottle every eight days.
Study the drainage tube expulsion rate, the incidence of blockage anddredging, the drainage efficacy, the incidence of air reflux, the disposable multifunctional drainage bags’ infection, the operating time-consuming, thepatient satisfaction in the pericardial effusion drainage process of the twogroups comparatively.
Results:
1The expulsion rate,blockage rate and the dredging rate of the drainagetube：there were20cases of pericardial effusion in the experimental group, thedrainage tube connector loose had occurred0times, the expulsion rate was0%;the blockage of the drainage tube had occurred5times, all of them weredredged, the blockage rate was15%and the dredging rate was100%;therewere20cases of pericardial effusion in the control group, the drainage tubeconnector loose had occurred5times, the expulsion rate was25%; theblockage of the drainage tube had occurred10times,2of them were dredged,the blockage rate was50%and the dredging rate was20%, P<0.05, there weresignificant statistical difference between the two groups, The experimentalgroup was obviously less than the control group in the expulsion rate andblockage rate of the drainage tube, higher than the control group in thedredging rate of the drainage tube.
2The effective rate of treatment: In the experimental group, there were15cases complete remission,4cases partial remission，the total cases were19,the effective rate was95%; In the control group, there were14cases completeremission,4cases partial remission，the total cases were18, the effective ratewas95%, P>0.05, There was no significant statistical difference between thetwo groups.
3The incidence of air reflux: In the experimental group, the air refluxoccurred1time, the incidence of air reflux was5%, the reason was the brokenof central venous catheters in vitro; In the control group air reflux occurred7times, the incidence rate was35%. All of them were iatrogenic airregurgitation. The reasons were bottles slipped off the central venous catheter,There was significant statistical difference between the two groups, P<0.05.The experimental group was obviously less than the control group in theincidence of air reflux.
4The rate of fluid contamination in the drainage bag (bottle): Thegermiculture of the fluid in the drainage bag (bottle) was examinated everyeight days. In the experimental group, there were32times of the examinationof the germiculture, and none fluid contamination occured, the rate was0%,in the control group, there were39times of the examination of thegermiculture,there were6cases of fluid contamination.3cases of them werePseudomonas aeruginosa,2cases of them were S. aureus, and1cases was E.coli. The rate of fluid contamination was15%, There was significant statisticaldifference between the two groups, P<0.05. The experimental group wasobviously lower than the control group.
5The operating time between the two groups：There were47times drainagein the experimental group, the average time was48.75±10.84s; in thecontrol group, there was49times drainage, the average time was270.95±44.76s, There was significant statistical difference between the two groups,P<0.0001. The experimental group was obviously lower than the controlgroup.
6The satisfaction rate of the two groups: There were14cases in theexperimental group expressed satisfaction, the satisfaction rate was95%; therewere7cases in the control group expressed satisfaction,the satisfaction ratewas35%.There was significant statistical difference between the two groups,P <0.05. The experimental group was obviously higher than the control group.
Conclusion: During the process of draining the pericardial effusion, theexpulsion rate, the blockage rate, the time consuming as well as the incidenceof air reflux in the clinical operations are less than those of the self-madedrainage bottle; the dredging rate and the patient satisfaction rate are higherthan those of self-made drainage bottle. The rate of fluid contamination in thedrainage bag is lower than that of the self-made drainage bottle.It isconfirmed that the effectiveness and safety of the disposable multifunctionaldrainage bag in the clinical applications is higher. This study shows that theapplication of the bag in the process of draining the pericardial effusion isbetter than that of self-made seal bottle. The clinical operation is convenient, simple, and the drainage system with good effectiveness and safety can bewidely used.
目的：探讨一次性多功能引流袋连接中心静脉导管对恶性心包积液进行引流，与传统的自制引流瓶对比研究，评价一次性多功能引流袋在临床应用中的安全性及有效性。
方法：本实验收集2010-9至2011-10就诊于河北医科大学第四医院呼吸科住院患者40例，均经心包积液脱落细胞学检查找到癌细胞而确诊为恶性心包积液，其中女性11例，男性29例；年龄36~72岁，平均年龄56.5±9.4岁；均经超声证实为中-大量心包积液；排除主动脉夹层合并心包积液者，不能纠正的凝血性疾病患者，正在行抗凝治疗的，有出血倾向或血小板低于50×10~9/L的心包积液，位于后壁或局限的心包积液，漏出液以及心包感染所致的非肿瘤性渗出液，肝功能衰竭、肾功能衰竭等疾病患者。按患者住院顺序随机分为2组，实验组及对照组。实验组：于超声定位下，采用Seldinger技术放入ARROW中心静脉导管行心包穿刺置管引流术，连接一次性多功能引流袋引流和收集心包积液，整个过程无菌操作。采用持续引流方法，引流速度为5-10ml/min，逐渐将心包积液引流干净，避免短时间大量引流造成急性右心扩张等并发症，每次心包内注入顺铂20mg和白介素-Ⅱ40万单位（顺铂总量不超过160mg），夹毕引流管48～72小时。之后再次持续引流心包积液直至干净为止，重复上述治疗。如24小时引流量小于25ml，并经B超确定为心包积液量极少或消失后，可拔出引流管。对照组：于超声定位下采用Seldinger技术放入ARROW中心静脉导管行心包穿刺置管引流术，连接自制引流瓶引流和收集心包积液。严格遵守无菌操作，心包引流和注药过程与实验组相同。多功能引流袋和自制引流瓶每8天更换。
比较对照两组患者心包积液引流治疗过程中，多功能引流袋和自制引流瓶（引流袋/瓶）连接管脱落、堵塞情况和疏通结果，恶性心包积液治疗效果，气体心包返流发生率，引流袋/瓶内液体污染率，引流袋/瓶安装或更换时间和患者满意程度。
结果：
1引流管脱落率、堵塞率、疏通成功率：实验组20例心包积液患者中，引流管接头脱落发生0例，发生率为0%，引流管堵塞发生3例，全部疏通成功，堵塞率及疏通成功率分别为15%和100%；对照组20例心包积液患者中，引流管接头脱落发生5例，发生率为25%，引流管堵塞发生10例，疏通成功2例，堵塞率及疏通成功率分别为50%和20%，各项指标均为P＜0.05，两组比较有显著统计学差异，实验组引流管接头脱落率、堵塞率低于对照组，疏通成功率高于对照组
2治疗有效率：实验组20例心包积液患者中，完全缓解15例，好转4例，总有效19例，有效率为95%；对照组20例心包积液患者中，完全缓解14例，好转4例，总有效18例，有效率为90%，P＞0.05，两组比较无显著统计学差异。
3气体返流发生率：实验组20例心包积液患者中，气体返流发生1例，发生率为5%，返流原因为中心静脉导管体外段发生断裂；对照组20例心包积液患者中，气体返流发生7例，发生率为35%，均为医源性气体返流，原因为引流管过滤膜乳头端与中心静脉导管连接脱落和引流瓶内气体反流，P＜0.05，两组有显著统计学差异，实验组气体返流发生率明显低于对照组。
4引流袋（瓶）内液体污染率：实验组20例心包积液患者中，每8天抽取引流袋内积液一次，送检细菌学培养，共32次，均细菌培养阴性，引流袋内液体污染率为0%；对照组20例心包积液患者中，送检细菌学培养39次，引流瓶内液体培养阳性6例，铜绿假单胞菌3例，金葡菌2例，大肠杆菌1例，引流瓶内液体污染率为15%，P＜0.05，两组有显著统计学差异，实验组引流袋内液体细菌污染率明显低于对照组。
5引流袋（瓶）安装或更换时间：实验组20例心包积液患者中，共接受引流袋安装和更换47次，每次安装或更换时间16～35秒，平均为48.75±10.84秒；对照组20例心包积液患者中，共接受引流瓶安装和更换49次，每次安装或更换时间180～420秒，平均为270.95±44.76秒，P＜0.001，两组比较有显著统计学差异，实验组安装及更换时间显著低于对照组。
6患者满意率：实验组20例心包积液患者中，对引流袋非常满意14例，满意5例，满意率95%；对照组20例心包积液患者中，对引流瓶非常满意3例，满意4例，满意率35%；P＜0.05，两组比较有显著统计学差异，实验组患者满意率明显高于对照组。
结论：
在恶性心包积液治疗过程中，引流袋引流管脱落率、堵塞率、安装或更换时间、气体返流发生率均低于自制引流瓶；疏通成功率及患者满意程度高于自制引流瓶；引流袋内液体污染发生率低于自制引流瓶。证实一次性多功能引流袋临床应用的安全性及有效性。
本研究显示一次性多功能引流袋在恶性心包积液治疗过程中优于自制水封瓶，临床安装或更换方法简单，密闭性好，安全性高，佩戴美观舒适，引流效果确实，是恶性心包积液治疗中与中心静脉导管适配的专用引流袋，应当积极推广和应用。
Pericardial effusion is a clinical manifestation of a variety ofcauses. With the continuous improvement of the diagnosis and treatmenttechnology, the risk factors resulting in cancer increases, and the incidenceand detection rates of the tumor continue to increase, causing the proportion ofmalignant pericardial effusion is rising. The rapid accumulation of largepericardial effusion in the pericardium can lead to cardiac tamponade, whichwill threaten the life. The most direct, effective treatment is the pericardialdecompression. And the pericardiocentesis catheter drainage has been widelyused because of its simplicity and safety. Now the drainage devices matchingwith the central venous catheter are lack in clinical. The clinicians often usematerials produce drainage devices, such as self-made drainage bottles andordinary drainage bags. However, the production process is time consuming,easy dropping off, easy to pollution, inconvenient to use as well as otherproblems. The one-time disposable multifunctional drainage bag (Patent No.:ZL200,920,255,142.7) developed by our department has resolved the aboveproblems, and the safety and efficacy in the process of draining the pericardialeffusion has improved remarkably.
Objective: Through the comparative study on the traditional self-madedrainage bottle and the disposable multifunctional drainage bag connecting tothe central venous catheter to drain the pericardial effusion, evaluate the thesafety and efficacy of the disposable multifunctional drainage bag in theclinical application.
Methods: In this experiment, we collected40patients who werehospitalized for malignant pericardial effusion in the Department RespiratoryMedicine of The Forth Hospital of Hebei Medical University(2010.9~2011.3), including11women and29men, aged from36to72, mean age (56.5±9.4)years. They were diagnosed as malignant pericardial effusion by find cancercells in pericardial effusion cytology. They were all confirmed by ultrasoundwith moderate or severe pericardial effusion. The pericardial effusion patientswho with aortic dissection, clotting disorders not be corrected, the patientsunder anticoagulant therapy, the pericardial effusion patients with bleedingtendency or thrombocytopenia below50×10~9/L, the pericardial effusion inthe posterior wall or of the limitations, transudate, the non-neoplastic effusioncaused by pericardial infection and the patients with Liver function failure andrenal failure are ruled out. The patients were randomly divided into twogroups, experimental and control groups. Experimental group: Through theultrasound, use the Seldinger technique to position ARROWpericardiocentesis catheter drainage, and connect the bag to drain thepericardial effusion. The whole process is under aseptic manipulation. Wedrainaged the pericardial effusion continully, keeping the speed in5-10ml/min, to be avoided acute right heart dilation by drainage a lot ofpericardial effusion in a short-term. Inject20mg/time of cisplatin (the totalamount of cisplatin does not exceed120mg) and40million units/time ofinterleukin-II to the pericardium, and clip the drainage tube for48-72hours. Then, drain the pericardial effusion until no effusion left. If thedrainage volume in the24-hour is less than25ml and through theidentification of B-ultrasound, there is small amount of pericardial effusion,you can pull out the drainage tube. Control group: Through the B-ultrasound,use the Seldinger technique to position ARROW pericardiocentesis catheterdrainage, and connect the self-made bottle to drain the pericardial effusion.The aseptic manipulation will be carried out strictly, and the process and thepericardial injection are the same with those of the experimentalgroup. Charge the disposable multifunctional drainage bag or the self-madedrainage bottle every eight days.
Study the drainage tube expulsion rate, the incidence of blockage anddredging, the drainage efficacy, the incidence of air reflux, the disposable multifunctional drainage bags’ infection, the operating time-consuming, thepatient satisfaction in the pericardial effusion drainage process of the twogroups comparatively.
Results:
1The expulsion rate,blockage rate and the dredging rate of the drainagetube：there were20cases of pericardial effusion in the experimental group, thedrainage tube connector loose had occurred0times, the expulsion rate was0%;the blockage of the drainage tube had occurred5times, all of them weredredged, the blockage rate was15%and the dredging rate was100%;therewere20cases of pericardial effusion in the control group, the drainage tubeconnector loose had occurred5times, the expulsion rate was25%; theblockage of the drainage tube had occurred10times,2of them were dredged,the blockage rate was50%and the dredging rate was20%, P<0.05, there weresignificant statistical difference between the two groups, The experimentalgroup was obviously less than the control group in the expulsion rate andblockage rate of the drainage tube, higher than the control group in thedredging rate of the drainage tube.
2The effective rate of treatment: In the experimental group, there were15cases complete remission,4cases partial remission，the total cases were19,the effective rate was95%; In the control group, there were14cases completeremission,4cases partial remission，the total cases were18, the effective ratewas95%, P>0.05, There was no significant statistical difference between thetwo groups.
3The incidence of air reflux: In the experimental group, the air refluxoccurred1time, the incidence of air reflux was5%, the reason was the brokenof central venous catheters in vitro; In the control group air reflux occurred7times, the incidence rate was35%. All of them were iatrogenic airregurgitation. The reasons were bottles slipped off the central venous catheter,There was significant statistical difference between the two groups, P<0.05.The experimental group was obviously less than the control group in theincidence of air reflux.
4The rate of fluid contamination in the drainage bag (bottle): Thegermiculture of the fluid in the drainage bag (bottle) was examinated everyeight days. In the experimental group, there were32times of the examinationof the germiculture, and none fluid contamination occured, the rate was0%,in the control group, there were39times of the examination of thegermiculture,there were6cases of fluid contamination.3cases of them werePseudomonas aeruginosa,2cases of them were S. aureus, and1cases was E.coli. The rate of fluid contamination was15%, There was significant statisticaldifference between the two groups, P<0.05. The experimental group wasobviously lower than the control group.
5The operating time between the two groups：There were47times drainagein the experimental group, the average time was48.75±10.84s; in thecontrol group, there was49times drainage, the average time was270.95±44.76s, There was significant statistical difference between the two groups,P<0.0001. The experimental group was obviously lower than the controlgroup.
6The satisfaction rate of the two groups: There were14cases in theexperimental group expressed satisfaction, the satisfaction rate was95%; therewere7cases in the control group expressed satisfaction,the satisfaction ratewas35%.There was significant statistical difference between the two groups,P <0.05. The experimental group was obviously higher than the control group.
Conclusion: During the process of draining the pericardial effusion, theexpulsion rate, the blockage rate, the time consuming as well as the incidenceof air reflux in the clinical operations are less than those of the self-madedrainage bottle; the dredging rate and the patient satisfaction rate are higherthan those of self-made drainage bottle. The rate of fluid contamination in thedrainage bag is lower than that of the self-made drainage bottle.It isconfirmed that the effectiveness and safety of the disposable multifunctionaldrainage bag in the clinical applications is higher. This study shows that theapplication of the bag in the process of draining the pericardial effusion isbetter than that of self-made seal bottle. The clinical operation is convenient, simple, and the drainage system with good effectiveness and safety can bewidely used.
引文
1孙寅光,毛原飞,Farouk Mookadam,等.心包积液的病因演变、临床特点和治疗：瑞金医院经验1996至2005[J].上海医学杂志,2007,30(增刊):236
2吴金义,陈玉华,麻薇,等.689例心包积液及误诊分析[J].中国循环杂志,1998,13(3):152-154
3吕家高,倪黎,汪适文.115例心包积液患者病因及临床分析[J].临床内科杂志,2006,23(3):191-192
4徐成胜,吴勇波,何涛,等.心包积液住院患者的病因分析(附384例报告)[J].临床心血管病杂志,2008,24(10):794-795
5黄流强,陆健,阮锡勇,等,Seldinger法心包穿刺置管引流术并发症的观察[J],实用心脑肺血管病杂志,2011,19(8):1364-1365
6朱瑛,刘宏,陈丽萍,等.超声引导心包穿刺65例临床研究[J].中国实用医药,2007,2(1):34
7廖清高,郭舜奇,陈纪平,等.中心静脉导管心包腔留置引流术治疗心包积液[J],中国综合临床,2003,19(2):161-162
8柳仓生,张军,张捷,等, B超引导穿刺治疗心包积液[J],中国医学影像技术,2004,20(11):1801-1802
9郑涛.穿刺置入引流管与引流袋连接方法的改进[J].中华医院感染学杂志,2001,21(5):1036
10何流,钱志英.含铂类联合化疗方案治疗晚期非小细胞肺癌的临床研究[J].中国肿瘤临床与康复,2003,10(6):523-526
11Argall J,Desmond J.Seldinger technique chest drain and complicationrate[J].Emerg Med J,2003,20(2):169-170
12翁毅敏,谷力加,冯卫能,等,中心静脉导管引流治疗肺癌致心包积液[J].中山大学学报,2004,25(3S):230-231
13高峰,李秋艳,孙建国,等,中心静脉导管引流并心包内化疗治疗肺癌致心包积液[J].癌症,2001,20(4):429-430
14荣莉.深静脉导管用于胸腔积液引流的护理[J].现代医药卫生,2006,22(19):3024
15Weyman AE.Principles and practice of echocardiography.2nd Edition.Philadephia: Lea&Febiger,1993.15
16陈文斌,潘祥林,康熙雄,等.诊断学[M].北京:人民卫生出版社,2004:368.
17Fiorentino MV, Daniele O, Morandi P,et al. Intrapericardial instillation ofplatinum in malignant pericardial effusion[J],Cancer.1988,62(9):1904-1906
18Guberman BA, Fowler NO, Engei PJ, et o1. Cardiac tamponade in medicalpatients. Circulation,1981,64:633
19周南方,蔡酒绳.缩窄性心包炎的二维超声心动图诊断[J].中国实用内科杂志,1995,15(2):88
20苗齐,于洪泉,任华,等.剑突下心包开窗术治疗大量心包积液[J],中国医学科学院学报,1998,20(3):216-217
1Boltwood CM,Skulsy A,Drinkwater CD,et al. Intraoperative mea-surement of pericardial constraint: Role in ventricular diastolicmechanias.JACC,1986,8:1289
2寿锡凌,陈新义,刘新宏,等.心包腔容积—压力关系的临床研究[J].心功能杂志,1999,11(4):232-233
3孙寅光,毛原飞,Farouk Mookadam,等.心包积液的病因演变、临床特点和治疗：瑞金医院经验1996至2005[J].上海医学杂志,2007,30(增刊):236
4吴金义,陈玉华,麻薇,等.689例心包积液及误诊分析[J].中国循环杂志,1998,13(3):152-154
5吕家高,倪黎,汪适文.115例心包积液患者病因及临床分析[J].临床内科杂志,2006,23(3):191-192
6徐成胜,吴勇波,何涛,等.心包积液住院患者的病因分析(附384例报告)[J].临床心血管病杂志,2008,24(10):794-795
7张锐,杨松青,孙莹.85例血性心包积液的病因及诊断方法分析[J].临床心血管病杂志,2007,23(12):913-915
8朱玲军,彭万军,林文辉,等. DNA倍体分析在恶性心包积液诊断中的应用[J].实用中西医结合临床,2007,7(3):67-68
9LEVY P Y, FOURNIER P E, CHARREL R, et al.Molecular analysis ofpericardial fluid: a7-year expe-rience[J]. Eur Heart J,2006,27:1942-1943.
10GUPTA K, MATHUR V S. Diagnosis of pericardialdisease usingpercutaneous biopsy: case report and lit-erature review[J]. Tex Heart Inst J,2003,30:130-131
11Weyman AE.Principles and practice of echocardiography.2ndEdition.Philadephia: Lea&Febiger,1993.15
12Guberman BA, Fowler NO, Engei PJ, et o1. Cardiac tamponade in medicalpatients. Circulation,1981,64:633
13黄流强,陆健,阮锡勇,等,Seldinger法心包穿刺置管引流术并发症的观察[J],实用心脑肺血管病杂志,2011,19(8):1364-1365
14朱瑛,刘宏,陈丽萍,等.超声引导心包穿刺65例临床研究[J].中国实用医药,2007,2(1):34
15廖清高,郭舜奇,陈纪平,等.中心静脉导管心包腔留置引流术治疗心包积液[J],中国综合临床,2003,19(2):161-162
16刘坤申,夏岳,叶蔚,等,心包穿刺硅胶管引流103例经验总结[J],中国实用内科杂志,2000,20(10):605-606
17杨曙光,苏玉文,张燕,等.心包穿刺置管引流38例分析[J],临床心血管病杂志,2005,21(5):315-316
18Paul T. Subxiphoid pericardiotomy in the diagnosis and management oflargepericardial effusions Assoeiated with alignancy．Chest,1992,101:938-943
19苗齐,于洪泉,任华,等.剑突下心包开窗术治疗大量心包积液[J],中国医学科学院学报,1998,20(3):216-217
20Piehler JM,Pluth JR,Schaff HV,et al．Surgical management of effusivepericardial disease[J], Thorac Cardiovasc Surg,1985,90:506-516
21曲家骐,高听,侯胜平,等.预防胸腔镜手术并发症的体会[J],中华胸心血管外科杂志,2005,21(2)：67-71
22田文庆,黄定,刘建华,等,经皮穿刺球囊扩张心包开窗术治疗顽固性大量心包积液[J],新疆医学,1995,25(1):15-16
23Ziskind A,Pearce A,Lemmon C,et al. Percutaneous balloonperi-cardiotomy for the treatment of cardiac tamponade and largepericardial effusions:description of technique and report of thefirst50cases,JAm Coll C
2吴金义,陈玉华,麻薇,等.689例心包积液及误诊分析[J].中国循环杂志,1998,13(3):152-154
3吕家高,倪黎,汪适文.115例心包积液患者病因及临床分析[J].临床内科杂志,2006,23(3):191-192
4徐成胜,吴勇波,何涛,等.心包积液住院患者的病因分析(附384例报告)[J].临床心血管病杂志,2008,24(10):794-795
5黄流强,陆健,阮锡勇,等,Seldinger法心包穿刺置管引流术并发症的观察[J],实用心脑肺血管病杂志,2011,19(8):1364-1365
6朱瑛,刘宏,陈丽萍,等.超声引导心包穿刺65例临床研究[J].中国实用医药,2007,2(1):34
7廖清高,郭舜奇,陈纪平,等.中心静脉导管心包腔留置引流术治疗心包积液[J],中国综合临床,2003,19(2):161-162
8柳仓生,张军,张捷,等, B超引导穿刺治疗心包积液[J],中国医学影像技术,2004,20(11):1801-1802
9郑涛.穿刺置入引流管与引流袋连接方法的改进[J].中华医院感染学杂志,2001,21(5):1036
10何流,钱志英.含铂类联合化疗方案治疗晚期非小细胞肺癌的临床研究[J].中国肿瘤临床与康复,2003,10(6):523-526
11Argall J,Desmond J.Seldinger technique chest drain and complicationrate[J].Emerg Med J,2003,20(2):169-170
12翁毅敏,谷力加,冯卫能,等,中心静脉导管引流治疗肺癌致心包积液[J].中山大学学报,2004,25(3S):230-231
13高峰,李秋艳,孙建国,等,中心静脉导管引流并心包内化疗治疗肺癌致心包积液[J].癌症,2001,20(4):429-430
14荣莉.深静脉导管用于胸腔积液引流的护理[J].现代医药卫生,2006,22(19):3024
15Weyman AE.Principles and practice of echocardiography.2nd Edition.Philadephia: Lea&Febiger,1993.15
16陈文斌,潘祥林,康熙雄,等.诊断学[M].北京:人民卫生出版社,2004:368.
17Fiorentino MV, Daniele O, Morandi P,et al. Intrapericardial instillation ofplatinum in malignant pericardial effusion[J],Cancer.1988,62(9):1904-1906
18Guberman BA, Fowler NO, Engei PJ, et o1. Cardiac tamponade in medicalpatients. Circulation,1981,64:633
19周南方,蔡酒绳.缩窄性心包炎的二维超声心动图诊断[J].中国实用内科杂志,1995,15(2):88
20苗齐,于洪泉,任华,等.剑突下心包开窗术治疗大量心包积液[J],中国医学科学院学报,1998,20(3):216-217
1Boltwood CM,Skulsy A,Drinkwater CD,et al. Intraoperative mea-surement of pericardial constraint: Role in ventricular diastolicmechanias.JACC,1986,8:1289
2寿锡凌,陈新义,刘新宏,等.心包腔容积—压力关系的临床研究[J].心功能杂志,1999,11(4):232-233
3孙寅光,毛原飞,Farouk Mookadam,等.心包积液的病因演变、临床特点和治疗：瑞金医院经验1996至2005[J].上海医学杂志,2007,30(增刊):236
4吴金义,陈玉华,麻薇,等.689例心包积液及误诊分析[J].中国循环杂志,1998,13(3):152-154
5吕家高,倪黎,汪适文.115例心包积液患者病因及临床分析[J].临床内科杂志,2006,23(3):191-192
6徐成胜,吴勇波,何涛,等.心包积液住院患者的病因分析(附384例报告)[J].临床心血管病杂志,2008,24(10):794-795
7张锐,杨松青,孙莹.85例血性心包积液的病因及诊断方法分析[J].临床心血管病杂志,2007,23(12):913-915
8朱玲军,彭万军,林文辉,等. DNA倍体分析在恶性心包积液诊断中的应用[J].实用中西医结合临床,2007,7(3):67-68
9LEVY P Y, FOURNIER P E, CHARREL R, et al.Molecular analysis ofpericardial fluid: a7-year expe-rience[J]. Eur Heart J,2006,27:1942-1943.
10GUPTA K, MATHUR V S. Diagnosis of pericardialdisease usingpercutaneous biopsy: case report and lit-erature review[J]. Tex Heart Inst J,2003,30:130-131
11Weyman AE.Principles and practice of echocardiography.2ndEdition.Philadephia: Lea&Febiger,1993.15
12Guberman BA, Fowler NO, Engei PJ, et o1. Cardiac tamponade in medicalpatients. Circulation,1981,64:633
13黄流强,陆健,阮锡勇,等,Seldinger法心包穿刺置管引流术并发症的观察[J],实用心脑肺血管病杂志,2011,19(8):1364-1365
14朱瑛,刘宏,陈丽萍,等.超声引导心包穿刺65例临床研究[J].中国实用医药,2007,2(1):34
15廖清高,郭舜奇,陈纪平,等.中心静脉导管心包腔留置引流术治疗心包积液[J],中国综合临床,2003,19(2):161-162
16刘坤申,夏岳,叶蔚,等,心包穿刺硅胶管引流103例经验总结[J],中国实用内科杂志,2000,20(10):605-606
17杨曙光,苏玉文,张燕,等.心包穿刺置管引流38例分析[J],临床心血管病杂志,2005,21(5):315-316
18Paul T. Subxiphoid pericardiotomy in the diagnosis and management oflargepericardial effusions Assoeiated with alignancy．Chest,1992,101:938-943
19苗齐,于洪泉,任华,等.剑突下心包开窗术治疗大量心包积液[J],中国医学科学院学报,1998,20(3):216-217
20Piehler JM,Pluth JR,Schaff HV,et al．Surgical management of effusivepericardial disease[J], Thorac Cardiovasc Surg,1985,90:506-516
21曲家骐,高听,侯胜平,等.预防胸腔镜手术并发症的体会[J],中华胸心血管外科杂志,2005,21(2)：67-71
22田文庆,黄定,刘建华,等,经皮穿刺球囊扩张心包开窗术治疗顽固性大量心包积液[J],新疆医学,1995,25(1):15-16
23Ziskind A,Pearce A,Lemmon C,et al. Percutaneous balloonperi-cardiotomy for the treatment of cardiac tamponade and largepericardial effusions:description of technique and report of thefirst50cases,JAm Coll C