Shapiro M J, Yanofsky S D, Trapp J, Durham R M, Labovitz A, Sear J E, Barth C W, Pearson A C
Department of Surgery, St. Louis University Medical Center, MO 63110-0250.
J Trauma. 1991 Jun;31(6):835-9; discussion 839-40. doi: 10.1097/00005373-199106000-00015.
Blunt chest trauma can result in significant cardiothoracic injury, which can include cardiac contusion, aortic injury, and myocardial valvular injury. Nineteen patients with no prior history of cardiac abnormalities who sustained severe blunt chest trauma and had widening of the mediastinum on chest radiographs were prospectively evaluated using transesophageal echocardiography (TEE). In each instance TEE was performed without difficulty, excellent images were obtained of the aorta and heart, and no complications were noted. Abnormalities were seen in 12 (63%) patients, with hypokinetic regional wall motion consistent with cardiac contusion demonstrated in five (26%) patients. Tricuspid regurgitation was found in three (16%) patients, and aortic and mitral regurgitation in one (5%) patient each. Aortic wall hematomas were seen in two patients, one of whom had an intimal tear on aortography, and a pericardial effusion was seen in one patient with an aortic intimal tear confirmed angiographically. Thus TEE can be performed safely in the acute setting of patients sustaining severe blunt chest trauma and yield useful information with respect to cardiovascular function and the aorta.
钝性胸部创伤可导致严重的心胸损伤，包括心脏挫伤、主动脉损伤和心肌瓣膜损伤。对19例既往无心脏异常病史、遭受严重钝性胸部创伤且胸部X线片显示纵隔增宽的患者，采用经食管超声心动图（TEE）进行前瞻性评估。每次TEE检查均顺利完成，获得了主动脉和心脏的优质图像，且未发现并发症。12例（63%）患者出现异常，5例（26%）患者表现为与心脏挫伤相符的节段性室壁运动减弱。3例（16%）患者发现三尖瓣反流，1例（5%）患者发现主动脉瓣反流，1例（5%）患者发现二尖瓣反流。2例患者可见主动脉壁血肿，其中1例在主动脉造影时发现内膜撕裂，1例经血管造影证实有主动脉内膜撕裂的患者可见心包积液。因此，在遭受严重钝性胸部创伤患者的急性期，可安全地进行TEE检查，并能提供有关心血管功能和主动脉的有用信息。
