Degiannis Elias, Loogna Peter, Doll Dietrich, Bonanno Fabrizio, Bowley Douglas M, Smith Martin D
Department of Surgery, Chris Hani Baragwanath Hospital, University of Witwatersrand, Johannesburg, South Africa.
World J Surg. 2006 Jul;30(7):1258-64. doi: 10.1007/s00268-005-0463-5.
Penetrating cardiac injury is a dramatic and lethal form of trauma. The majority of patients will die before reaching medical care, but for those who arrive at hospital alive, the diagnostic acumen and rapid surgical intervention of physicians and surgeons can lead to successful outcomes.
A structured diagnostic and management approach is used in our trauma unit to deal with penetrating cardiac injury. A retrospective study of 117 patients with penetrating trauma to the heart was conducted over 32 months; the purpose of this study was to describe our protocol and review overall outcome with this type of injury. Demographic details, mechanism of injury, and mode of presentation were recorded. Mortality and morbidity data were collated and echocardiographic follow-up was performed.
There were 109 male patients, mean age 29 years (range: 15-54 years) and 8 female patients, mean age 35 years (range: 23-56 years). Most patients (96/117) had sustained stab wounds, and the associated mortality was 15.6%. Twenty-one patients had sustained gunshot wounds (GSW), with a mortality of 81%. Gunshot wounds were significantly more likely to result in death (P<or=0.0001). Five patients sustained multiple cardiac wounds, and three of them died. The risk of death was not different between patients sustaining single or multiple cardiac wounds (P=0.11). Eleven patients had thoracoabdominal injury, and 3/11 (27%) died; all of those that died had sustained GSW. The risk of death was not different between patients sustaining thoracoabdominal wounds and those with isolated thoracic injury (P=1.0). Among the 51 patients with stab wounds who presented with cardiac tamponade, the mortality was only 8%. Compared to the other patients with stab wounds, cardiac tamponade conferred a significant survival advantage (P=0.02).
A high index of suspicion for penetrating cardiac injury and an understanding of the modes of presentation can lead to rapid diagnosis even by inexperienced junior staff. Such a structured approach to patients with penetrating trauma to the chest leads to early definitive management and acceptable results.
穿透性心脏损伤是一种严重且致命的创伤形式。大多数患者在获得医疗救治前就会死亡，但对于那些存活到达医院的患者，医生和外科医生的诊断敏锐度及快速手术干预可带来成功的治疗结果。
我们的创伤治疗单元采用结构化的诊断和管理方法来处理穿透性心脏损伤。对117例心脏穿透伤患者进行了为期32个月的回顾性研究；本研究的目的是描述我们的治疗方案并评估此类损伤的总体治疗结果。记录了人口统计学细节、损伤机制及临床表现方式。整理了死亡率和发病率数据，并进行了超声心动图随访。
男性患者109例，平均年龄29岁（范围：15 - 54岁），女性患者8例，平均年龄35岁（范围：23 - 56岁）。大多数患者（96/117）为刺伤，相关死亡率为15.6%。21例患者为枪伤，死亡率为81%。枪伤导致死亡的可能性显著更高（P≤0.00０1）。5例患者有多处心脏伤口，其中3例死亡。单处或多处心脏伤口患者的死亡风险无差异（P = 0.11）。11例患者有胸腹联合伤，3/11（27%）死亡；所有死亡患者均为枪伤。胸腹联合伤患者与单纯胸部损伤患者的死亡风险无差异（P = 1.0）。在51例出现心脏压塞的刺伤患者中，死亡率仅为8%。与其他刺伤患者相比，心脏压塞具有显著的生存优势（P = 0.02）。
对穿透性心脏损伤保持高度怀疑指数，并了解其临床表现方式，即使是经验不足的初级医护人员也能实现快速诊断。这种针对胸部穿透伤患者的结构化方法可实现早期确定性治疗并取得可接受的治疗结果。
