蔣啟娟 李春亮

[摘要] 報(bào)道1例胎齡27周超低體重兒心包積液/填塞、動(dòng)脈導(dǎo)管開(kāi)胸閉合術(shù)的臨床表現(xiàn)、輔助檢查、原因分析和治療轉(zhuǎn)歸，并復(fù)習(xí)相關(guān)文獻(xiàn)。本例超低體重兒在生后第1天行臍靜脈置管，第9天出現(xiàn)心率增快、肝臟增大、呼吸機(jī)參數(shù)明顯上調(diào)，胸X線片示心胸比值0.8，心臟彩超示：心包腔內(nèi)大量積液、動(dòng)脈導(dǎo)管未閉（3.2 mm），立即拔除臍靜脈導(dǎo)管，B超定位下心包穿刺抽液，心包積液消失。經(jīng)內(nèi)科治療，動(dòng)脈導(dǎo)管未縮小，心力衰竭難以糾正、多次撤機(jī)失敗，出生后第36天手術(shù)結(jié)扎動(dòng)脈導(dǎo)管，術(shù)后心力衰竭糾正，順利撤機(jī)，體重增長(zhǎng)良好，正常出院。臍靜脈置管后新生兒臨床上突然病情惡化，出現(xiàn)呼吸困難、發(fā)紺、心率增快、肝臟增大，應(yīng)考慮心包積液/填塞可能，及時(shí)予B超確診并拔出臍靜脈導(dǎo)管、心包穿刺抽液減壓，降低死亡風(fēng)險(xiǎn)。內(nèi)科治療失敗的超低體重兒動(dòng)脈導(dǎo)管未閉，因血管細(xì)，從血管介入手術(shù)難度極大，可行開(kāi)胸結(jié)扎動(dòng)脈導(dǎo)管，有利于心力衰竭的糾正及順利撤機(jī)、體重增長(zhǎng)、盡早出院。

[關(guān)鍵詞] 超低體重兒;心包積液;心包填塞;動(dòng)脈導(dǎo)管閉合術(shù)

[中圖分類(lèi)號(hào)] R815? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] C? ? ? ? ? [文章編號(hào)] 1673-9701（2021）25-0152-03

One case and literature review of pericardial effusion/tamponade， arterial duct open and closed operation in ultra-low birth weight infant

JIANG Qijuan? ?LI Chunliang

Department of Neonatology， Guilin People′s Hospital in Guangxi Zhuang Autonomous Region， Guilin? ?541002， China

[Abstract] This paper reports the clinical manifestations， auxiliary examinations， cause analysis and treatment outcome of a pericardial effusion/tamponade and arterial duct thoracotomy in a 27-week gestational age infant with ultra-low birth weight， and reviews the relevant literature. The ultra-low birth weight infant underwent umbilical vein catheterization on the first day after birth. On the 9th day， the child had a faster heart rate， an enlarged liver， and a significant increase in ventilator parameters. The chest X-ray showed a cardiothoracic ratio of 0.8. Heart color Doppler ultrasound showed a large amount of fluid in the pericardial cavity and patent ductus arteriosus （3.2 mm）. The umbilical vein catheter was immediately removed. The pericardial puncture fluid was drawn under the B-ultrasound positioning， and the pericardial effusion disappeared. After medical treatment，the ductus arteriosus did not shrink， heart failure was difficult to correct， and repeated weaning failed. On the 36th day after birth， the ductus arteriosus was surgically ligated. Postoperative heart failure was corrected. The ventilator was removed successfully， and the weight gain was good. She was discharged normally.After the umbilical vein catheterization， the newborn′s condition suddenly deteriorated clinically， with dyspnea， cyanosis，increased heart rate， and enlarged liver. The possibility of pericardial effusion/tamponade should be considered. The timely diagnosis of B-ultrasound and the removal of the umbilical venous catheter and pericardiocentesis fluid for decompression reduced the risk of death. In ultra-low birth weight infants with the ductus arteriosus who have failed medical treatment， transvascular interventional surgery is extremely difficult because of the thin blood vessels.It is feasible to open the thorax and ligate the ductus arteriosus， which is conducive to the correction of heart failure， smooth weaning， weight gain， and early discharge.