創傷後復發性之心包出血及心包膜炎－－病例報告

Post-Traumatic Recurrent Pericardium Hemorrhage & Pericarditis : Case Report

創傷性心包出血尤其是胸腹部鈍傷引起之心包出血，因初使症狀不明顯，經常被忽略，以致於在創傷後數小時甚至數日後發生出血性心包塡塞，因而危及病患生命。本個案爲車禍意外，在他院處理後轉入本院治療，住院後數小時，病患以意識改變及肢體發紺來表現心包塡塞，重新檢視影像學檢查的結果後，在超音波引導下進行心包放液，解除心包塡塞的狀況，意外發生後6週，門診追蹤時再一次發現心包積液，但不同於意外發生時的急性心包塡塞，這次病患的生命徵象穩定，無任何不適及症狀，因此給予保守性的治療，意外發生後三個月，心包積液明顯減少，目前心包積液已完全消失，心臟功能正常，並未發現窄縮性心包膜炎的發生。

Traumatic pericardium hemorrhage caused by blunt thoraco- abdominal injuries was often overlooked by previous occult symptoms or signs. It is life-threatening that delayed hemorrhagic cardiac tamponade was not treated during post-traumatic days or even hours. We report a case of 19 years old male with cardiac tamponade which presented with conscious change and limbs cyanosis after several hours of traffic accidents. Sonoguided pericardiocentesiswas performed for cardiac hemodynamics. Patient was discharged healthy afterward. Recurrent pericardial effusion was noted during outpatient department 6 weeks after the traffic accident. There were no acute signs of tamponade or any subjective physical discomfort by patient himself, thus we give conservative treatment. During 12th weeks follow-up, there were no pericardial effusion or constrictive patho-physiology, and with a normal heart function.