Pericardiotomy and drainage

Suppurative pericarditis should be diagnosed as pericardial incision and drainage, and should not be delayed. Treating diseases: pericarditis Indication Suppurative pericarditis should be diagnosed as pericardial incision and drainage, and should not be delayed. Preoperative preparation 1. Anti-infective treatment. 2. Systemic support therapy to correct anemia, low plasma protein and electrolyte imbalance. 3. If the ascites is serious and affects the breathing and circulation, the ascites may be appropriately relieved to reduce the pressure. Generally, it should be carried out on the 2nd and 3rd day before the operation. 4. If the heart is severely stressed, and can not immediately perform pericardial incision and drainage, pericardial puncture and decompression can be performed before drainage to improve cardiopulmonary function. Surgical procedure Practice has proved that the traditional pericardial incision drainage method has many drawbacks, and this surgical method has proved to be superior to the traditional method. 1. Position: The slope is lying. 2. Incision: A 5 cm transverse incision was made along the left 5th costal cartilage, and the costal cartilage was removed about 4 cm from the costal bed into the precordial area. If there is pleural coverage, push it to the left. 3. For the pericardial traction line: push the loose connective tissue before the pericardium to reveal the pericardium with thickened edema, and make two traction lines on the anterior wall of the pericardium. 4. Puncture: puncture between the two traction lines. If pus is obtained, the anterior wall of the pericardium is clearly defined. 5. Cut the happy bag: Cut the happy bag between the traction lines, and immediately put the suction device into the pericardial cavity to attract the pus to avoid overflow. After draining the pus, use your fingers to reach into the pericardium, probe around, separate all the cellulose septa, peel off the cellulose block attached to the pericardium or heart, and pour it out. 6. Excision of part of the pericardium: Under the condition of not expanding the chest wall incision, the pericardium of the anterior wall should be removed as much as possible (the electrosurgical can be used to stop bleeding at the same time. If the electrosurgical unit is not used, the pericardial vascular should be sutured). The anterior wall pericardium is completely cut off to the diaphragm, so that the pericardial cavity and the anterior mediastinum are freely transported without obstruction. 7. Place the drainage tube: Place a soft rubber drainage tube in the anterior mediastinum. The inner diameter of the tube is not less than 0.8cm. Cut 1 to 2 side holes and cut a small opening between the xiphoid process and the left rib arch. Note that the drainage tube is not placed in the pericardial cavity, but placed in the anterior mediastinum of the free communication with the pericardium to avoid irritating the heart. 8. Suture incision: After suturing the drainage port, the drainage tube is fixed with a ligature. The incision is sutured in two layers, that is, the muscle is a layer, and the subcutaneous tissue and the skin are another layer. After suturing the muscles, rinse the wound thoroughly and then suture the skin.