Oosterloo M, Nieuwland W, Zijlstra F
Universitair Medisch Centrum Groningen, Groningen.
Ned Tijdschr Geneeskd. 2007 Jan 13;151(2):108-14.
A 65-year-old man had a pneumohaemothorax and fractured ribs after an automobile accident. Troponine concentrations were normal and the initial electrocardiographic abnormalities resolved within 24 hours. A 46-year-old man who was also in an automobile accident developed a seat-belt haematoma and lung oedema. Troponine concentrations were increased, the electrocardiogram was abnormal and transthoracic ultrasound revealed severe myocardial contusion. After a few weeks of treatment, both patients were discharged without cardiac complications. It is clinically important to identify patients at risk of developing myocardial contusion following blunt thoracic trauma. A combination oftroponine and electrocardiography is necessary to differentiate between risk categories. Echocardiography has a role in haemodynamically unstable patients and whenever the clinical condition of the patient deteriorates. A structured approach to screening and evaluation, as presented in an algorithm, can be used as a guide in the follow-up of patients with myocardial contusion.
一名65岁男性在车祸后发生血气胸和肋骨骨折。肌钙蛋白浓度正常，最初的心电图异常在24小时内消失。另一名同样遭遇车祸的46岁男性出现了安全带血肿和肺水肿。肌钙蛋白浓度升高，心电图异常，经胸超声显示严重心肌挫伤。经过几周的治疗，两名患者均未出现心脏并发症而出院。识别钝性胸部创伤后有发生心肌挫伤风险的患者在临床上很重要。肌钙蛋白和心电图相结合对于区分风险类别是必要的。超声心动图在血流动力学不稳定的患者以及患者临床状况恶化时发挥作用。如算法中所示的结构化筛查和评估方法可作为心肌挫伤患者随访的指导。
