心脏刺伤的处理：10年73例病例分析

Management of stab wounds of the heart: analysis of 73 cases in 10 years.

作者信息

Gwely N N, Mowafy A, Khalaf S, Amer S, Hamza U, El-Saeed M

机构信息

Cardiothoracic Surgery, Mansoura Faculty of Medicine, Mansoura, Egypt.

出版信息

Thorac Cardiovasc Surg. 2010 Jun;58(4):210-4. doi: 10.1055/s-0029-1240921. Epub 2010 May 31.

DOI:10.1055/s-0029-1240921

PMID:20514575

Abstract

BACKGROUND

Stab wounds of the heart still cause a significant number of traumatic deaths every year. The aim of this study was to assess the outcome of patients with cardiac stab wounds requiring emergency thoracotomy.

PATIENTS AND METHODS

Preoperative and operative variables were reviewed for all patients treated at the Mansoura Emergency Hospital between August 1998 and July 2008.

RESULTS

Seventy-three patients were treated for stab wounds of the heart. Of these 69 were male (94.5 %) and only 4 were female (5.5 %). Mean patient age was 28.5 +/- 5.8 years. The clinical status was stable in 22 patients (30.1 %) and unstable in 26 patients (35.6 %), while 10 patients were in shock (13.7 %), and 15 patients had suffered cardiac arrest prior to thoracotomy (20.6 %). Emergency room (ER) thoracotomy was performed in 18 patients (24.7 %) and operative room (OR) thoracotomy was carried out in 55 patients (75.3 %). The commonest location of stab wounds to the heart was the right ventricle in 28 patients (38.4 %) followed by the left ventricle in 25 patients (34.2 %). Mortality was 23.3 % (17 patients), and morbidity was 21.4 % (12 patients out of 56 surviving patients). Prognostic factors included clinical status (patients in shock or cardiac arrest had a mortality rate of 50 % and 60 %, respectively), cardiopulmonary resuscitation (CPR; mortality rate: 68.2 %) and ER thoracotomy (mortality rate: 66.7 %).

CONCLUSION

Clinical status as shock, CPR and ER thoracotomy were prognostic of a poor outcome and associated with high mortality rates.

摘要

背景

心脏刺伤每年仍导致大量创伤性死亡。本研究的目的是评估需要急诊开胸手术的心脏刺伤患者的预后。

患者与方法

回顾了1998年8月至2008年7月在曼苏拉急诊医院接受治疗的所有患者的术前和手术变量。

结果

73例患者接受了心脏刺伤治疗。其中69例为男性（94.5%），仅4例为女性（5.5%）。患者平均年龄为28.5±5.8岁。22例患者（30.1%）临床状态稳定，26例患者（35.6%）不稳定，10例患者休克（13.7%），15例患者在开胸手术前发生心脏骤停（20.6%）。18例患者（24.7%）进行了急诊室（ER）开胸手术，55例患者（75.3%）进行了手术室（OR）开胸手术。心脏刺伤最常见的部位是右心室，共28例（38.4%），其次是左心室，共25例（34.2%）。死亡率为23.3%（17例患者），发病率为21.4%（56例存活患者中的12例）。预后因素包括临床状态（休克或心脏骤停患者的死亡率分别为50%和60%）、心肺复苏（CPR；死亡率：68.2%）和ER开胸手术（死亡率：66.7%）。