O'Connor J, Ditillo M, Scalea T
University School of Medicine, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA.
J R Army Med Corps. 2009 Sep;155(3):185-90. doi: 10.1136/jramc-155-03-02.
It is understood that penetrating cardiac trauma is a highly lethal injury and those surviving to hospital have an overall mortality approaching 80%. Reported mortality figures vary widely and are extremely dependent on mechanism of wounding, cardiac chambers involved and possibly the presence of cardiac tamponade. Despite significant advances in prehospital care, operative techniques, and intensive care management, the mortality has not changed over several decades. This article will review the anatomic regions of concern for a cardiac injury, clinical presentation, and physical findings. The need for an expeditious evaluation and modalities available including, plain radiographs, sub-xiphoid window, and echocardiography will be considered. Options for surgical exposure, technical details of repairing cardiac injuries, and special circumstances such as injury adjacent to a coronary artery and intra-cardiac shunts are discussed in detail. Outcome data and future directions in managing this challenging injury are also examined.
据了解，穿透性心脏创伤是一种极具致死性的损伤，能够存活至医院的患者总体死亡率接近80%。报告的死亡率数据差异很大，并且极大地取决于致伤机制、受累心腔以及可能存在的心包填塞情况。尽管在院前急救、手术技术和重症监护管理方面取得了显著进展，但几十年来死亡率并未改变。本文将回顾心脏损伤相关的解剖区域、临床表现和体格检查结果。还将考虑快速评估的必要性以及可用的检查方式，包括X线平片、剑突下视窗和超声心动图。详细讨论了手术显露的选择、心脏损伤修复的技术细节以及诸如冠状动脉附近损伤和心内分流等特殊情况。还研究了处理这种具有挑战性损伤的结果数据和未来方向。
