Fulda G, Brathwaite C E, Rodriguez A, Turney S Z, Dunham C M, Cowley R A
Shock Trauma Center, Maryland Institute for Emergency Medical Services Systems, Baltimore 21201-1595.
J Trauma. 1991 Feb;31(2):167-72; discussion 172-3.
Blunt traumatic rupture of the heart and pericardium, rarely diagnosed preoperatively, carries a high mortality rate. From 1979 to 1989, more than 20,000 patients were admitted to a Level I trauma center. A retrospective review identified 59 patients requiring emergency surgery for this condition. Injuries resulted from vehicular accidents (68%), motorcycle crashes (10%), pedestrians being struck by vehicles (7%), falls (5%), crushing (7%), and being struck by a horse (2%) or crane (2%). Seventeen patients (29%) had isolated rupture of the pericardium; 37 (63%) had ruptures of one or more cardiac chambers. All patients had signs of life at the scene or during transportation, but only 29 (49%) had vital signs on admission: 15 with chamber injury, 12 with pericardial rupture, and two with combined injuries. Diagnosis was established by emergency thoracotomy in the 30 patients who arrived in cardiac arrest. In the remaining 29 patients, diagnosis was made by urgent thoracotomy (41%), by subxiphoid pericardial window (34%), during laparotomy (21%), or by chest radiography (3%). The overall mortality rate was 76% (45 patients), but only 52% for those with vital signs on admission. Rapid transportation and expeditious surgical treatment can save many patients with these injuries.
钝性心脏和心包创伤性破裂术前很少被诊断出来，死亡率很高。1979年至1989年期间，超过20000名患者被收治于一家一级创伤中心。一项回顾性研究确定了59例因这种情况需要进行急诊手术的患者。损伤原因包括机动车事故（68%）、摩托车碰撞（10%）、行人被车辆撞击（7%）、跌倒（5%）、挤压伤（7%）以及被马（2%）或起重机（2%）撞击。17例患者（29%）为单纯心包破裂；37例（63%）为一个或多个心腔破裂。所有患者在现场或转运途中均有生命体征，但入院时仅有29例（49%）有生命体征：15例有心腔损伤，12例有心包破裂，2例为合并伤。30例心脏骤停入院的患者通过急诊开胸手术确诊。其余29例患者中，41%通过紧急开胸手术、34%通过剑突下心包开窗术、21%在剖腹手术期间、3%通过胸部X线检查确诊。总体死亡率为76%（45例患者），但入院时有生命体征的患者死亡率仅为52%。快速转运和迅速的手术治疗可以挽救许多此类受伤患者。
