El-Chami Mikhael F, Nicholson William, Helmy Tarek
Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.
J Emerg Med. 2008 Aug;35(2):127-33. doi: 10.1016/j.jemermed.2007.03.018. Epub 2007 Aug 2.
The incidence of cardiac injury after blunt chest trauma is difficult to determine and ranges from 8% to 76%. Moreover, the clinical presentation varies tremendously without a real gold standard to exclude or document cardiac involvement. Electrocardiogram as a single test is not sensitive or specific for diagnosing cardiac contusion. Furthermore, creatine kinase MB is non-reliable in the setting of severe trauma involving the liver, intestines or diaphragm. Although troponins T and I are highly specific for cardiac injury, their sensitivity in the setting of trauma is poor. The echocardiogram is very useful in the evaluation of trauma patients with suspected cardiac involvement. However, poor windows in the setting of chest and lung injuries and in intubated patients might be a major problem limiting the accuracy of transthoracic echocardiogram. On the other hand, transesophageal echocardiogram seems to be more sensitive and specific in trauma patients and should be the test of choice in patients with high clinical suspicion for blunt cardiac trauma.
钝性胸部创伤后心脏损伤的发生率难以确定，范围在8%至76%之间。此外，临床表现差异极大，且没有真正的金标准来排除或证实心脏受累情况。心电图作为单一检查手段，对诊断心脏挫伤既不敏感也不特异。此外，在涉及肝脏、肠道或膈肌的严重创伤情况下，肌酸激酶同工酶不可靠。尽管肌钙蛋白T和I对心脏损伤具有高度特异性，但其在创伤情况下的敏感性较差。超声心动图在评估疑似心脏受累的创伤患者时非常有用。然而，在胸部和肺部损伤以及插管患者中，声窗不佳可能是限制经胸超声心动图准确性的主要问题。另一方面，经食管超声心动图在创伤患者中似乎更敏感、更特异，对于临床高度怀疑钝性心脏创伤的患者应作为首选检查。
