在升主動脈剝離合併心包膜積血病患 於進行引流後突發休克

Acute Cardiovascular Collapse after Pericardial Drainage in a Patient with Aortic Dissection

近端之主動脈剝離常合併有心包膜填充，而早期之死亡率可高達60%。然而對於此種心包膜積血病患之最適當處理尚未有定論。我們報告一位術前診斷為主動脈腔內栓塞合併心包膜積水之病患，於術中經食道心臟超音波證實應為升主動脈瘤並壓迫左右心房。於接受引流之後突然發生休克，於急救無效後死亡。在主動脈剝離併心包膜填充之病患應祝為外科急症，理想做法應為，直接進入手術室進行主動脈修補及術中心包膜積血引流，而避免先進行心包膜穿刺。若進行心包膜穿刺，麻醉醫師則應更積極處理病患血壓，以減低主動脈剝離進一步之惡化。

Proximal aortic dissection is frequently associated with cardiac tamponade. The treatment sometimes is difficult. We present a 69-year-old female patient who after repeated episodes of syncope received an open drainage of peri-cardial effusion that ended in a fatal outcome. She was also known to have mural thrombi in the aorta. However, preanesthetic trransesophageal echocardiography revealed besides pericardial effusion, also dilatation of aortic root which compressed both atria. She developed sudden cardiovascular collapse following drainage of pericardial effusion to which she succumbed in spite of vigorous resuscitation. We suggest that the patients with cardiac tam-ponade complicated by aortic dissection must receive direct aortic repair together with intraoperative pericardial drainage. Selective or single pericardiocentesis should better be avoided.