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== 讨论 == In our case, hemorrhagic pericardial fluid without clots was removed from the pericardial space and analyzed. 在我们的病例中,从心包腔中取出没有凝块的出血性心包积液并进行分析。 A pericardial effusion is a potentially life-threatening problem; it causes an increase in the intrapericardial pressure resulting in varying degrees of hemodynamic compromise (5). The common causes of pericardial effusion in the dog include peritoneopericardial diaphragmatic hernia, congenital cysts, infectious pericarditis, right-sided heart failure, uremia, left atrial rupture, idiopathic pericardial effusion, cardiac neoplasia, and hemorrhage secondary to neoplasia (6). Pericardial effusion caused by rodenticide intoxication has been rarely reported in the veterinary literature. Petrus and Henik (1) reported successful pericardiocentesis in a dog that had ingested brodifacoum rodenticide; they drained the pericardial fluid into the pleural space without retrieving it for cytologic analysis. In our case, hemorrhagic pericardial fluid without clots was removed from the pericardial space and analyzed. 心包积液是一种可能危及生命的问题;它会导致心包内压升高,导致不同程度的血流动力学受损 (5)。狗心包积液的常见原因包括新心包膈疝、先天性囊肿、感染性心包炎、右心力衰竭、尿毒症、左心房破裂、特发性心包积液、心脏肿瘤和继发于肿瘤的出血 (6)。杀鼠剂中毒引起的心包积液在兽医文献中很少见。Petrus 和 Henik (1) 报道了一只摄入了溴敌菌杀鼠剂的狗的心包穿刺术成功;他们将心包积液引流到胸膜腔中,而没有将其取出进行细胞学分析。在我们的病例中,从心包腔中取出没有凝块的出血性心包积液并进行分析。 The rapid and appropriate emergency management involving pericardiocentesis may have contributed to the initial stabilization of the intoxicated dog in this case. The ventricular tachycardia associated with the pericardiocentesis was likely due to irritation of the myocardial surface by the catheter during the procedure and resolved after administration of 2% lidocaine hydrochloride. Despite this complication, these arrhythmias are usually self-limited following the retraction of the needle or catheter (7). 在这种情况下,涉及心包穿刺术的快速和适当的应急管理可能有助于醉酒狗的初步稳定。与心包穿刺术相关的室性心动过速可能是由于手术过程中导管对心肌表面的刺激,并在给予 2% 盐酸利多卡因后消退。尽管有这种并发症,但这些心律失常通常在针头或导管回缩后具有自限性 (7)。 In human medicine, anticoagulants, such as warfarin, have been used for prevention and therapy of coronary artery diseases and previous reports have described the development of pericardial effusions associated with this anticoagulation therapy in humans (8–10). Despite strong evidence favoring a causative role of anticoagulation in the genesis of late cardiac tamponade from intrapericardial bleeding (11,12), there is not a clear answer to the question of whether anticoagulant treatment promotes development of pericardial effusion (13). Cardiac biomarkers (cTnI and CK-MB) were significantly increased in this dog. According to the study by Shaw et al (14), dogs with pericardial effusion had significantly higher serum levels of cTnI than did normal dogs. Dogs with hemangiosarcoma had much higher concentrations of cTnI (2.77 ng/dL; range: 0.09 to 47.18 ng/dL) than did dogs with idiopathic pericardial effusion (0.05 ng/dL; range: 0.03 to 0.09 ng/dL)(P , 0.001) (14). Our data were similar to the values obtained with idiopathic pericardial effusion. Gastrointestinal bleeding could be a possible cause of elevated serum urea nitrogen, CRSC, ALP, and NH3. Increased serum AST, LDH, and CK might be caused by tissue damage in this case. 在人类医学中,抗凝剂(如华法林)已被用于预防和治疗冠状动脉疾病,以前的报道描述了与这种抗凝治疗相关的人类心包积液的发展 (8–10)。尽管有强有力的证据表明抗凝治疗在心包内出血导致晚期心包填塞的发生中具有致病作用 (11,12),但对于抗凝治疗是否促进心包积液发展的问题尚无明确的答案 (13)。 这只狗的心脏生物标志物(cTnI 和 CK-MB)显着增加。根据 Shaw 等人 (14) 的研究,心包积液狗的血清 cTnI 水平明显高于正常狗。血管肉瘤患者的cTnI浓度(2.77 ng/dL;范围:0.09-47.18 ng/dL)远高于特发性心包积液(0.05 ng/dL;范围:0.03-0.09 ng/dL)(P,0.001)(14)。我们的数据与特发性心包积液获得的值相似。消化道出血可能是血清尿素氮、CRSC、ALP 和 NH3 升高的可能原因。在这种情况下,血清 AST、LDH 和 CK 升高可能是由组织损伤引起的。 In veterinary medicine, if a pericardial effusion is suspected as a result of rodenticide intoxication, it is important for veterinarians to confirm the presence of the pericardial effusion by using echocardiography, and then perform a routine pericardiocentesis for a better therapeutic prognosis. 在兽医学中,如果怀疑杀鼠剂中毒导致心包积液,兽医必须使用超声心动图确认心包积液的存在,然后进行常规心包穿刺术以获得更好的治疗预后。 <br>
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