Südkamp M, Geissler H J, de Vivie E R
Department of Cardiothoracic Surgery, University of Cologne, Germany.
Thorac Cardiovasc Surg. 2000 Dec;48(6):373-5. doi: 10.1055/s-2000-8339.
Patients with penetrating cardiac injury usually present with cardiac tamponade and shock upon hospital arrival. However, absence of hemodynamic depression does not exclude a potentially fatal injury of the heart. This article reports on a patient who developed neither hemodynamic depression nor ECG changes for several hours, despite two left ventricular lacerations with puncture of the LAD. Echocardiography is advocated as the diagnostic tool of choice, and it is emphasized that no penetrating objects should be removed from the wound before surgical access to the heart is established, as this may result in the sudden development of cardiac tamponade.
穿透性心脏损伤患者入院时通常表现为心脏压塞和休克。然而，血流动力学无抑制并不排除心脏存在潜在致命损伤。本文报道了一名患者，尽管左心室有两处裂伤且伴有前降支穿孔，但数小时内既无血流动力学抑制也无心电图改变。提倡将超声心动图作为首选诊断工具，并强调在建立心脏手术入路之前，不应从伤口移除任何穿透性物体，因为这可能导致心脏压塞突然发生。
