Thourani V H, Feliciano D V, Cooper W A, Brady K M, Adams A B, Rozycki G S, Symbas P N
Department of Surgery, Grady Memorial Hospital, Atlanta, Georgia 30303, USA.
Am Surg. 1999 Sep;65(9):811-6; discussion 817-8.
This is a report of a 22-year experience with penetrating cardiac trauma at a single urban Level I trauma center. We conducted a retrospective chart review supplemented by computerized patient log. Comparisons of mortality between Period 1 (1975-1985; 113 patients) and Period 2 (1986-1996; 79 patients) were by chi2 or Fisher's exact tests. Statistical significance was defined as P < or = 0.05. From 1975 to 1996, 192 patients (mean age, 32 years; 88% male) with penetrating cardiac stab wounds (68%) or gunshot wounds (32%) were treated. The most common initial clinical presentation was cardiac tamponade, and most patients (54%) were hypotensive (systolic blood pressure 30-90 mm Hg). The most common initial intervention in the emergency center was tube thoracostomy. The use of pericardiocentesis as a diagnostic and therapeutic modality in the emergency center virtually disappeared in Period 2, as compared with Period 1. Since 1994, surgeon-performed cardiac ultrasound has been performed and has correctly diagnosed hemopericardium in 12 patients (100% survival). The overall mortality for all patients during the 22-year study interval was 25 per cent and was not significantly different between Period 1 (27%) and Period 2 (22%). The mortality associated with gunshot wounds was increased compared with that of stab wounds. Similarly, mortality for patients who arrested in the emergency center was increased compared with those patients who did not arrest. We conclude: 1) cardiac tamponade is the most common presentation in patients with cardiac wounds; 2) pericardiocentesis in the emergency center has essentially disappeared; 3) surgeon-performed ultrasound of the pericardium should improve survival of future patients who are normotensive or mildly hypotensive; 4) over the last 11 years, there has been a substantial decrease in mortality in patients with stab wounds and a statistically significant decrease in arrested patients; and 5) overall mortality for penetrating cardiac trauma has not changed during the 22-year interval.
这是一份关于一家城市一级创伤中心22年穿透性心脏创伤治疗经验的报告。我们进行了一项回顾性病历审查，并辅以计算机化患者日志。对第1阶段（1975 - 1985年；113例患者）和第2阶段（1986 - 1996年；79例患者）的死亡率进行了卡方检验或Fisher精确检验。统计学显著性定义为P≤0.05。1975年至1996年期间，共治疗了192例穿透性心脏刺伤（68%）或枪伤（32%）患者（平均年龄32岁；88%为男性）。最常见的初始临床表现是心脏压塞，大多数患者（54%）血压降低（收缩压30 - 90 mmHg）。急诊中心最常见的初始干预措施是胸腔闭式引流术。与第1阶段相比，在第2阶段急诊中心几乎不再使用心包穿刺术作为诊断和治疗手段。自1994年以来，由外科医生进行心脏超声检查，已正确诊断出12例心包积血患者（全部存活）。在22年的研究期间，所有患者的总体死亡率为25%，第1阶段（27%）和第2阶段（22%）之间无显著差异。与刺伤相比，枪伤相关的死亡率有所增加。同样，在急诊中心心脏骤停患者的死亡率高于未骤停患者。我们得出以下结论：1）心脏压塞是心脏创伤患者最常见的表现；2）急诊中心的心包穿刺术基本已不再使用；3）由外科医生进行的心包超声检查应能提高未来血压正常或轻度降低患者的生存率；4）在过去11年中，刺伤患者的死亡率大幅下降，心脏骤停患者的死亡率有统计学显著性下降；5）在22年期间，穿透性心脏创伤的总体死亡率没有变化。
