Pericardial effusion examination
The serosal cavity of the human body has a pericardial cavity, a pleural cavity, and a peritoneal cavity. Under normal conditions, there is only a small amount of liquid in the cavity, which acts as a slip. However, under pathological conditions, there may be a large amount of fluid in the cavity, called serosal effusion, such as pericardial effusion, pleural effusion. Check the amount of fluid, appearance, pH, relative density, protein, glucose and microscopy, etc., to distinguish the nature of the effusion, and then find out the cause and conduct diagnosis and treatment.Basic Information
Specialist classification: cardiovascular examination classification: chest and ascites examination
Applicable gender: whether men and women apply fasting: not fastingTips: Clinically, pericardial effusion does not need to be identified as leakage and exudate. Normal value
There is a small amount of pericardial fluid (20 ~ 25ml) in the pericardial cavity, which is a light yellow transparent liquid.Clinical significance
(1) increased amount seen in bacterial pericarditis, tuberculous pericarditis, fungal pericarditis, viral pericarditis, mycotic pericarditis, metastatic tumors, aortic aneurysm rupture, uremia, mucinous edema, rheumatism, Systemic lupus erythematosus, etc., or in trauma, when using anticoagulant drugs.
(2) turbidity is found in infective pericardial effusion, neoplastic pericardial effusion (mainly typed lung cancer, breast cancer).
(3) The milky white is found in the lymphatic system damage.
(4) Blood is found in pericardial lesions, and anticoagulant drugs are used.
(5) The number of white blood cells is >10×109/L, which is found in bacterial infective pericardial effusion, tuberculous pericardial effusion, neoplastic pericardial effusion, etc. (neutrophil elevation is seen in pericardial effusion of bacterial endocarditis) ).
(6) Glucose <2.22mmol/L, found in bacterial infective pericardial effusion, tuberculous pericardial effusion, rheumatism, malignant tumors, etc.Precautions
Clinically, pericardial effusion does not need to be identified as leakage and exudate.Inspection process
1. Pericardial puncture method is to take part of the effusion for laboratory examination of related causes. The detection methods include microscopic examination and biochemical method.
2, X-ray examination, the heart shadow is generally enlarged to both sides (more than 300 ml of effusion), when the large amount of fluid (more than 1000 ml), the heart shadow is in the form of a flask, the shadow of the superior vena cava is widened, and the heart beats weakly under fluoroscopy. Clear lung fields can be distinguished from heart failure.Not suitable for the crowd
Unintentional effusion detection indications should not be detected.Adverse reactions and risks
Pericardial puncture complications:
(1) Infection: Strict aseptic operation, postoperative attention to local hygiene and cleanliness, to avoid postoperative infection.
(2) Myocardial injury: master the direction of the puncture and the depth of the needle. The needle insertion speed is slow. When there is a feeling of entering the pericardial cavity, the liquid is pumped back. If there is no liquid, the needle has no heart beat feeling, and the fashion can be slowly pulled forward. If the needle has a heart beat, immediately retract the needle and take another direction to avoid damage to the heart and heart vessels.
(3) Air embolism: The pumping speed should be slow. The first pumping volume should be about 100m1. After each pumping, 300~500ml, avoid excessive pumping and lead to acute heart expansion. The assistant should pay attention to closing the hose at any time to prevent air from entering the pericardial cavity.
(4) Others: During the operation, the patient's pulse, complexion, heart rate, and heart rate changes should be closely observed. If there is any collapse, the puncture should be stopped immediately, and the patient should be placed in a supine position and given appropriate treatment. After lying down, the pulse, breathing and blood supply were closely observed within 24 hours. Pericardial puncture under ECG or ECG oscillography.