提供纵隔血肿的全面介绍。
纵隔血肿是一种罕见的并发症,在心脏导管插入术后胸痛的鉴别诊断中通常不考虑。
从2006年1月1日至2013年12月31日,在阜外医院,126,265例患者接受了冠状动脉造影(CAG);其中121,215例经桡动脉接受了CAG。最终,包括10例因心导管插入术引起的纵隔血肿患者。患者的临床特征,诊断,治疗,并对预后进行回顾性分析。
心导管术和经桡动脉心导管术纵隔血肿发生率分别为0.79和0.74,分别。在所有10例纵隔血肿患者中都使用了超级滑动亲水导丝。这些患者在手术期间/之后感到胸痛和呼吸困难,和计算机断层扫描(CT)用于诊断纵隔血肿。其中,两名患者有颈部血肿。所有患者术后血红蛋白水平均大幅下降。3名未植入支架的患者停止抗血小板治疗8-20天,然后只开了口服阿司匹林。一名接受经皮冠状动脉介入治疗的患者暂时停用阿司匹林2天。其他人继续服用双重抗血小板药物。两名患者接受输血。没有支架血栓形成的病例,并且未对任何患者进行手术。在9.0±2.5年的随访中,出院后未观察到并发症。
疑似纵隔血肿患者应尽早行CT检查。纵隔血肿的预后通常较好,早期诊断和适当治疗。
To provide a comprehensive introduction of mediastinal hematoma.
Mediastinal hematoma is a rare complication that is usually not considered in the differential diagnosis of chest pain after cardiac catheterization.
From January 1, 2006, to December 31, 2013, at Fuwai Hospital, 126,265 patients underwent coronary angiography (CAG); 121,215 of them underwent CAG via the radial artery. Ultimately, 10 patients with mediastinal hematoma due to cardiac catheterization were included. Patients\' clinical characteristics, diagnosis, treatment, and prognosis were retrospectively analyzed.
The incidences of mediastinal hematoma in cardiac catheterization and transradial cardiac catheterization were 0.79‱ and 0.74‱, respectively. A super slide hydrophilic guidewire was used in all 10 patients with mediastinal hematoma. These patients felt chest pain and dyspnea during/after the procedure, and computed tomography (CT) was used to diagnose mediastinal hematoma. Among them, two patients had a neck hematoma. The post-procedural hemoglobin level decreased substantially in all patients. Antiplatelet therapy was discontinued for 8-20 days in three patients without stents implanted, and then only oral aspirin was prescribed. Aspirin was transiently discontinued for 2 days in one patient undergoing percutaneous coronary intervention. The others continued taking dual antiplatelet drugs. Two patients received blood transfusion. There was no case of stent thrombosis, and surgery was not indicated for any patient. No complication was observed after discharge during the 9.0 ± 2.5-year follow-up.
CT should be performed as early as possible in patients with suspected mediastinal hematoma. The prognosis of mediastinal hematoma is usually good with early diagnosis and suitable therapy.