钝性心脏损伤：从法医那里学到的经验教训。

Blunt cardiac trauma: lessons learned from the medical examiner.

作者信息

Teixeira Pedro G R, Georgiou Chrysanthos, Inaba Kenji, Dubose Joseph, Plurad David, Chan Linda S, Toms Carla, Noguchi Thomas T, Demetriades Demetrios

机构信息

Division of Trauma Surgery and Surgical Critical Care, University of Southern California, USC and LAC Medical Center, 1200 North State Street, Room 10-750, Los Angeles, CA 90033, USA.

出版信息

J Trauma. 2009 Dec;67(6):1259-64. doi: 10.1097/TA.0b013e318187a2d2.

DOI:10.1097/TA.0b013e318187a2d2

PMID:20009675

Abstract

OBJECTIVE

The objective of this study was to analyze autopsy findings after blunt traumatic deaths to identify the incidence of cardiac injuries and describe the patterns of associated injuries.

METHODS

All autopsies performed by the Los Angeles County Forensic Medicine Division for blunt traumatic deaths in 2005 were retrospectively reviewed. Only cases that underwent a full autopsy including internal examination were included in the analysis. The study population was divided into two groups according to the presence or absence of a cardiac injury and compared for differences in baseline characteristics and types of associated injuries.

RESULTS

Of the 881 fatal victims of blunt trauma received by the Los Angeles County Forensic Medicine Division, 304 (35%) underwent a full autopsy with internal examination and were included in the analysis. The mean age was 43 years +/- 21 years, patients were more often men (71%) and were intoxicated in 39% of the cases. The most common mechanism was motor vehicle collision (50%), followed by pedestrian struck by auto (37%), and 32% had a cardiac injury. Death at the scene was significantly more common in patients with a cardiac injury (78% vs. 65%, p = 0.02). The right chambers were the most frequently injured (30%, right atrium; 27%, right ventricle). Among the 96 patients with cardiac injuries, 64% had transmural rupture. Multiple chambers were ruptured in 26%, the right atrium in 25%, and the right ventricle in 20% of these patients. Patients with cardiac injuries were significantly more likely to have other associated injuries: thoracic aorta (47% vs. 27%, p = 0.001), hemothorax (81% vs. 59%, p < 0.001), rib fractures (91% vs. 71%, p < 0.001), sternum fracture (32% vs. 13%, p < 0.001), and intra-abdominal injury (77% vs. 48%, p < 0.001) compared with patients without cardiac injury. Of the 96 patients with a cardiac injury, 78% died at the scene of the crash and 22% died en route or at the hospital.

CONCLUSION

Cardiac injury is a common autopsy finding after blunt traumatic fatalities, with the majority of deaths occurring at the scene. Patients with cardiac injuries are at significantly increased risk for associated thoracic and intra-abdominal injuries.

摘要

目的

本研究旨在分析钝性创伤死亡后的尸检结果，以确定心脏损伤的发生率，并描述相关损伤的模式。

方法

对洛杉矶县法医部门在2005年进行的所有钝性创伤死亡尸检进行回顾性研究。分析仅纳入进行了包括内部检查在内的完整尸检的病例。根据是否存在心脏损伤将研究人群分为两组，并比较基线特征和相关损伤类型的差异。

结果

洛杉矶县法医部门接收的881例钝性创伤致死受害者中，304例（35%）进行了包括内部检查在内的完整尸检并纳入分析。平均年龄为43岁±21岁，男性患者居多（71%），39%的病例存在中毒情况。最常见的致伤机制是机动车碰撞（50%），其次是行人被汽车撞击（37%），32%的患者存在心脏损伤。心脏损伤患者在现场死亡的情况明显更常见（78%对65%，p = 0.02）。右心腔是最常受伤的部位（右心房30%；右心室27%）。在96例心脏损伤患者中，64%发生了透壁破裂。这些患者中，26%的多腔室破裂，25%的右心房破裂，20%的右心室破裂。与无心脏损伤的患者相比，心脏损伤患者发生其他相关损伤的可能性显著更高：胸主动脉损伤（47%对27%，p = 0.001）、血胸（81%对59%，p < 0.001）、肋骨骨折（91%对71%，p < 0.001）、胸骨骨折（32%对13%，p < 0.001）和腹腔内损伤（77%对48%，p < 0.001）。在96例心脏损伤患者中，78%在车祸现场死亡，22%在途中或医院死亡。