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心包穿刺致快速性心房纤颤一例太原市人民医院（０３０００１）郝冬梅患者，女性，６４岁，主因胸憋，气短，心悸一周，颜面及下肢浮肿两天住院。入院后初步诊断：急性渗出性心包炎，性质待查（结核性？）。给予心包穿刺抽液治疗，术前做超声定位于心尖部，胸骨左缘第六肋间心浊音界左侧边缘稍内侧，操作过程顺利。术后血压１２．０／６．６７ｋＰａ，心率１５０次／分，律不齐，心音强弱不等，急查心电图：快速型心房纤颤，给予西地兰、安定等药治疗，２小时后恢复窦性心律，率９０／分，患者自觉症状明显好转。讨论：本例发病时心电示波无ＳＴ段抬高，提示针头未穿刺心脏，抽出心包积液１５０ｍｌ。当时考虑心房纤颤的原因：与疼痛刺激精神紧张有关，由于疼痛、精神紧张，致儿茶酚胺分泌增加，心率加快，心脏分布的交感神经节后纤维通过释放去甲肾上腺素，使窦房结和异常的起搏点的自律性增高，不应期缩短，冲动传导加速，在心房内发生多处微型折返所致快速的心房纤颤。因此在穿刺时要注意以下几点：①消除恐惧感，常规用镇静剂，必要时口服可待因０．０３ｇ，术时遮住患者双眼。②穿刺应在麻醉注射５分钟药效充分的情况下进针，嘱患者勿咳嗽及深呼吸。③进针勿过深及用力过猛，避免与心脏接触。④术
A case of rapid atrial fibrillation caused by pericardiocentesis Taiyuan Municipal People’s Hospital (030001) Hao Dongmei patients, female, 64 years old, mainly due to chest choke, shortness of breath, palpitations a week, face and lower extremity edema two days hospitalization. After admission, a preliminary diagnosis: acute exudative pericarditis, nature to be checked (tuberculous?). Given pericardiocentesis fluid treatment, preoperative ultrasound located in the apical Department, the left sternal border of the left intercostal heart sound left margin slightly medial, the operation was smooth. Postoperative blood pressure 12.0 / 6.67kPa, heart rate 150 beats / min, irregular heartbeat, heart sound intensity ranging from acute ECG: rapid atrial fibrillation, given cedilanid, stability and other drugs, 2 hours later Recovery of sinus rhythm, rate 90 / min, patients with symptoms improved significantly. Discussion: In this case, there was no ST-segment elevation in ECG, suggesting that the needle did not puncture the heart and the pericardial effusion was 150ml. At that time, the cause of atrial fibrillation was considered: it was related to pain-induced stress. Due to pain and mental stress, catecholamine secretion was increased and heart rate was accelerated. Cardiac distribution of sympathetic postganglionic fibers through the release of norepinephrine caused sinus node and abnormalities Of pacemaker points increased self-discipline, should not shorten the period, impulse conduction acceleration, occurred in the atrium multiple micro-reentry caused by rapid atrial fibrillation. Therefore, puncture should pay attention to the following points: ① eliminate the fear, the conventional use of sedatives, if necessary, oral codeine 0.03g, surgery to cover the eyes of patients. ② puncture should be injected anesthesia injection 5 minutes full effect of the needle, Zhu Huanzhe cough and take a deep breath. ③ needle into the deep and too hard, avoid contact with the heart. ④ surgery