Ann Surg. 1974 May;179(5):757-61. doi: 10.1097/00000658-197405000-00031.
Thirty-six patients with penetrating wounds of the great vessels treated at Grady Memorial Hospital during a 7-year period were reviewed. In more than 50% of the cases, diagnosis of the injury was made at the time of emergency thoracotomy for massive bleeding. In the remaining patients the diagnosis was suspected: 1) when the pulse distal to the vascular injury was absent or weak; 2) when the patient had symptoms and signs of impaired central nervous system perfusion; 3) when the missile had traversed the mediastinum and there was roentgenographic evidence of widening of the mediastinal shadow; or, 4) when a new murmur appeared. In all suspected cases with great vessel injury, the diagnosis was confirmed arteriographically. Arteriography in such patients should be performed to define the type and site of vascular injury so that its repair can be properly planned. Twenty-nine patients recovered from their injury, 6 succumbed as a result of it and 1 required midforearm amputation following repair of a subclavian artery and vein injury. Most of these patients underwent autotransfusion which greatly contributed to their successful outcome. Local temporary shunt was used for protection of the spinal cord and/or brain when impairment of their perfusion was required for the repair of the vascular wounds.
回顾了在 7 年期间在 Grady Memorial 医院接受治疗的 36 例大血管穿透伤患者。在超过 50%的病例中，在进行大量出血的紧急开胸手术时做出了损伤的诊断。在其余患者中，怀疑存在以下情况：1）当血管损伤远端的脉搏消失或微弱时；2）当患者出现中枢神经系统灌注受损的症状和体征时；3）当弹丸穿过纵隔且纵隔阴影增宽的 X 线证据存在时；或 4）当出现新杂音时。在所有疑似大血管损伤的病例中，均通过血管造影术确诊。在这些患者中应进行血管造影术，以明确血管损伤的类型和部位，从而可以妥善规划其修复。29 例患者从损伤中恢复，6 例患者因此死亡，1 例患者在修复锁骨下动静脉损伤后需要进行前臂中段截肢。这些患者大多接受了自身输血，这对他们的成功治疗有很大帮助。当需要修复血管伤口时，为了保护脊髓和/或大脑，使用局部临时分流术。
