Fallah-Nejad M, Wallace H W, Su C C, Kutty A C, Blakemore W S
Arch Surg. 1975 Nov;110(11):1357-62. doi: 10.1001/archsurg.1975.01360170097014.
Penetrating cardiac injuries frequently first appear in an unusual and insidious manner, and their diagnosis may not be immediately obvious. In a series of 20 cases of cardiac injury, ten cases were indicative of such subtle symptoms, several of which were life-threatening. These unusual manifestations can be categorized as early, intermediate, or late. Early problems of four patients included the following: (1) sudden onset of shock during laparotomy, performed due to apparent abdominal trauma; (2) cardiac arrest on arrival in the emergency room; and (3) cerebral air embolus and mimicked symptoms of possible irreversible anoxic brain damage. The intermediate manifestations of cardiac injury are usually discovered in the early recovery period, and include myocardial infarction with cardiogenic shock and bullet embolus to a peripheral artery. Intermediate manifestations were observed in two patients. Four patients had late complications that included pseudoaneurysm, ventricular septal defect, valvular damage, and recurrent pericarditis. These late complications were observed between one month and 21 years after cardiac injury. This indicates the necessity of long-term follow-up of these patients.
穿透性心脏损伤常常最初以一种不寻常且隐匿的方式出现，其诊断可能不会立刻明显显现。在一组20例心脏损伤病例中，有10例表现出此类细微症状，其中几例危及生命。这些不寻常的表现可分为早期、中期或晚期。4例患者的早期问题如下：（1）因明显的腹部创伤而进行剖腹手术期间突然发生休克；（2）抵达急诊室时心脏骤停；（3）脑空气栓塞及类似可能不可逆的缺氧性脑损伤的症状。心脏损伤的中期表现通常在早期恢复期被发现，包括心肌梗死伴心源性休克以及外周动脉的子弹栓塞。2例患者出现了中期表现。4例患者有晚期并发症，包括假性动脉瘤、室间隔缺损、瓣膜损伤和复发性心包炎。这些晚期并发症在心脏损伤后1个月至21年之间被观察到。这表明对这些患者进行长期随访的必要性。
