超低体重儿心包积液/填塞、动脉导管开胸闭合术1例并文献复习

蒋启娟 李春亮

[摘要] 報道1例胎龄27周超低体重儿心包积液/填塞、动脉导管开胸闭合术的临床表现、辅助检查、原因分析和治疗转归，并复习相关文献。本例超低体重儿在生后第1天行脐静脉置管，第9天出现心率增快、肝脏增大、呼吸机参数明显上调，胸X线片示心胸比值0.8，心脏彩超示：心包腔内大量积液、动脉导管未闭（3.2 mm），立即拔除脐静脉导管，B超定位下心包穿刺抽液，心包积液消失。经内科治疗，动脉导管未缩小，心力衰竭难以纠正、多次撤机失败，出生后第36天手术结扎动脉导管，术后心力衰竭纠正，顺利撤机，体重增长良好，正常出院。脐静脉置管后新生儿临床上突然病情恶化，出现呼吸困难、发绀、心率增快、肝脏增大，应考虑心包积液/填塞可能，及时予B超确诊并拔出脐静脉导管、心包穿刺抽液减压，降低死亡风险。内科治疗失败的超低体重儿动脉导管未闭，因血管细，从血管介入手术难度极大，可行开胸结扎动脉导管，有利于心力衰竭的纠正及顺利撤机、体重增长、尽早出院。

[关键词] 超低体重儿;心包积液;心包填塞;动脉导管闭合术

[中图分类号] R815          [文献标识码] C          [文章编号] 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.