Successful Resuscitation of a Cardiac Arrest Patient with Ruptured Acute Ascending Aortic Dissection after Pericardial Tamponade

急性主動脈剝離導致心包塡塞以及心臟停止經急救成功之案例

蔡文福(Wun-Fu Tsai) ； 邱冠明(Kwan-Ming Chiu) ； 朱樹勳(Shu-Hsun Chu)

《中華民國急救加護醫學會雜誌》 17卷4期 (2006/12) Pp. 169-174

https://doi.org/10.30018/JECCM.200612.0005

摘要

急性心包膜塡塞是無脈性心臟電氣活動(pulseless electrical activity; PEA)的原因之一而且不論在院內或院外的心臟停止救活率都不高。我們報告一位50歲的男性突然因昏迷而由救護車送至急診室，到達時，病人沒有自然呼吸而且模不到脈搏，但是床側心電圖顯示器顯示竇性心搏過速，所以立刻給予心肺復甦術，攜帶式超音波顯示心包膜內積水，馬上執行心包膜穿刺術，但是失敗，因此改由胸骨劍凸下方做心包膜窗口術，引流心包膜腔積液，術後血壓和心跳馬上恢復，緊急由心血管外科接手施行開心手術，發現升主動脈剝離予以修補手術，經治療後病患恢復正常出院。

關鍵字

急性主動脈剝離 ； 心包膜塡塞 ； 心包膜穿口術

並列摘要

Acute pericardial tamponade is one of the common causes of pulseless electrical activity and has a low survival rate as either in-hospital or out-of-hospital cardiac arrest. We present a 50-year-old male with sudden consciousness loss. On arrival at the Emergency Department, he was in a state of out-of-hospital cardiac arrest. Electrocardiogram monitoring(ECG) showed sinus tachycardia. Cardio-pulmonary-cerebral resuscitation was performed and a portable sonogram revealed pericardial effusion. Pericardiocentesis was performed, but this failed to drain the pericardial fluid and clot. Subsequently, subxiphoid pericardiotomy was performed. Heart beat and blood pressure returned and then emergency open-heart surgery was carried out involving graft repair of the ruptured dissecting ascending aortic aneurysm. The patient was discharged in good condition.

並列關鍵字

acute aortic dissection ； pericardial tamponade ； pericardiotomy