Teixeira Pedro G R, Inaba Kenji, Oncel Didem, DuBose Joseph, Chan Linda, Rhee Peter, Salim Ali, Browder Timothy, Brown Carlos, Demetriades Demetrios
Division of Trauma, Los Angeles County, University of Southern California Medical Center, Los Angeles, California 90033-4525, USA.
J Trauma. 2009 Oct;67(4):788-91. doi: 10.1097/TA.0b013e3181825bd8.
Because of its rarity and high rate of mortality, traumatic blunt cardiac rupture (BCR) has been poorly studied. The objective of this study was to use the National Trauma Data Bank to review the epidemiology and outcomes associated with traumatic BCR.
After approved by the institutional review board, the National Trauma Data Bank (version 5.0) was queried for all BCR occurring between 2000 and 2005. Demographics, clinical injury data, interventions, and outcomes were abstracted for each patient. Statistical analysis was performed using an unpaired Student's t test or Mann-Whitney U test to compare means and chi analysis to compare proportions. Stepwise logistic regression analysis was performed to identify independent predictors of inhospital mortality.
Of 811,531 blunt trauma patients, 366 (0.045%) had a BCR of which 334 were available for analysis, with the mean age of 45 years, 65% were men, and their mean Injury Severity Score was 58 +/- 19. The most common mechanism of injury was motor vehicle collision (73%), followed by pedestrian struck by auto (16%), and falls from height (8%). Twenty-one patients (6%) died on arrival and 140 (42%) died in the emergency room. The overall mortality for patients arriving alive to hospital was 89%. Of the patients surviving to operation, 42% survived >24 hours of which 87% were discharged. Survivors were significantly younger (39 vs. 46 years, p = 0.04), had a lower Injury Severity Score (47 vs. 56, p = 0.02), higher Glasgow Coma Scale (10 vs. 6, p < 0.001), and were more likely to present with an systolic blood pressure >or=90 mm Hg (p = 0.01). Nevertheless, none of these factors was found to be an independent risk factor for mortality.
BCR is an exceedingly rare injury, occurring in 1 of 2400 blunt trauma patients. In patients arriving alive to hospital, traumatic BCR is associated with a high mortality rate, however, is not uniformly fatal.
由于创伤性钝性心脏破裂（BCR）较为罕见且死亡率高，对其研究较少。本研究的目的是利用国家创伤数据库回顾与创伤性BCR相关的流行病学和转归情况。
经机构审查委员会批准后，查询国家创伤数据库（5.0版）中2000年至2005年间发生的所有BCR病例。提取每位患者的人口统计学资料、临床损伤数据、干预措施及转归情况。采用非配对学生t检验或曼-惠特尼U检验进行统计学分析以比较均值，采用卡方分析比较比例。进行逐步逻辑回归分析以确定院内死亡的独立预测因素。
在811,531例钝性创伤患者中，366例（0.045%）发生BCR，其中334例可供分析，平均年龄45岁，65%为男性，平均损伤严重度评分为58±19。最常见的致伤机制是机动车碰撞（73%），其次是行人被汽车撞击（16%）和高处坠落（8%）。21例（6%）患者到达时死亡，140例（42%）在急诊室死亡。存活至医院的患者总体死亡率为89%。存活至手术的患者中，42%存活超过24小时，其中87%出院。存活者明显更年轻（39岁对46岁，p = 0.04），损伤严重度评分更低（47对56，p = 0.02），格拉斯哥昏迷量表评分更高（10对6，p < 0.001），且更可能收缩压≥90 mmHg（p = 0.01）。然而，这些因素均未被发现是死亡的独立危险因素。
BCR是一种极其罕见的损伤，在2400例钝性创伤患者中发生1例。存活至医院的患者中，创伤性BCR死亡率高，但并非均为致命性。
