Blake D P, Gisbert V L, Ney A L, Helseth H K, Plummer D W, Ruiz E, Bubrick M P
Department of Surgery, Hennepin County Medical Center, Minneapolis, Minnesota 55415.
Am Surg. 1992 Jun;58(6):329-32; discussion 332-3.
The authors undertook a 6-year retrospective review to assess their experience with penetrating cardiac injuries. Special emphasis was placed on identifying patients with and without tamponade and those requiring emergency department (ED) thoracotomy. Forty-eight patients were identified. Overall survival was 64.6 per cent. Thirty-three patients had tamponade, with 20 requiring ED thoracotomy. Fifteen patients did not have tamponade and two of these needed ED thoracotomy. Five patients who had ED thoracotomy were long-term survivors (22.7%). The remaining 26 patients, 13 with tamponade and 13 without, received operating room (OR) thoracotomy and all survived. The data shows that excellent results are possible with OR thoracotomy for penetrating cardiac injuries, with or without tamponade. However, results are not as good when ED thoracotomy is necessary. This may relate to the severity of the injury, the duration of tamponade, or the inability to control cardiac bleeding during thoracotomy in the ED setting. Even though survival is low with ED thoracotomy, it is high enough to continue to support its use in the deteriorating patient with a penetrating cardiac wound.
作者进行了一项为期6年的回顾性研究，以评估他们处理穿透性心脏损伤的经验。特别强调识别有和没有心包填塞的患者以及那些需要在急诊科进行开胸手术的患者。共识别出48例患者。总体生存率为64.6%。33例患者有心包填塞，其中20例需要在急诊科进行开胸手术。15例患者没有心包填塞，其中2例需要在急诊科进行开胸手术。5例在急诊科进行开胸手术的患者为长期存活者（22.7%）。其余26例患者，13例有心包填塞，13例没有心包填塞，接受了手术室开胸手术，全部存活。数据表明，对于穿透性心脏损伤，无论有无心包填塞，手术室开胸手术都可能取得良好效果。然而，当需要在急诊科进行开胸手术时，效果则没那么好。这可能与损伤的严重程度、心包填塞的持续时间或在急诊科进行开胸手术时无法控制心脏出血有关。尽管急诊科开胸手术的生存率较低，但仍足以支持在有穿透性心脏伤口的病情恶化患者中继续使用该手术。
