Pearce W, Blair E
J Trauma. 1976 Feb;16(2):136-40. doi: 10.1097/00005373-197602000-00009.
In a series of 24 patients with major blunt chest trauma, 11 presented evidence of heart injury upon re-examination of serial ECGs and four were confirmed at autopsy. The clinical diagnosis had been recorded in only one patient. In every case of closed chest trauma, regardless of the degree of visible injury, cardiac injury must be suspected. A presumptive diagnosis is then made, usually on the basis of ECG changes, which cannot be ruled out by any other cause. Even in some cases with normal ECGs the clinician's suspicion is the only guide. With a presumptive diagnosis made, the patient is treated as is any patient with an irritable myocardium; bedrest, avoidance of conditions which may precipitate arrhythmias, and of fluid overload, and treatment of these complications as they arise. Anticoagulants are usually avoided. Followup for long periods is indicated, because of the occasional emergence of chronic constrictive pericarditis or ventricular aneurysm.
在一组24例严重钝性胸部创伤患者中，11例在连续复查心电图时出现心脏损伤迹象，4例经尸检证实。临床诊断仅记录在1例患者中。在每一例闭合性胸部创伤中，无论可见损伤程度如何，都必须怀疑有心脏损伤。然后通常根据心电图变化做出初步诊断，而这种变化不能用任何其他原因来解释。即使在一些心电图正常的病例中，临床医生的怀疑也是唯一的指导依据。做出初步诊断后，对患者的治疗方式与任何有应激性心肌的患者相同；卧床休息，避免可能诱发心律失常和液体超负荷的情况，并在出现这些并发症时进行治疗。通常避免使用抗凝剂。由于偶尔会出现慢性缩窄性心包炎或心室瘤，因此需要进行长期随访。
