Wani Mohd Lateef, Ahangar Abdul Gani, Lone Gh Nabi, Hakeem Zubair Ashraf, Dar Abdul Majeed, Lone Reyaz Ahmad, Bhat Mohd Akbar, Singh Shyam, Irshad Ifat
Department of Thoracic Surgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India.
J Emerg Trauma Shock. 2011 Apr;4(2):173-7. doi: 10.4103/0974-2700.82201.
Missile cardiovascular injuries have taken an epidemic proportion in Kashmir valley since the eruption of militancy in 1990. Present study was undertaken to analyse the pattern, presentation and management of missile cardiovascular injuries.
Three hundred and eighty-six patients with missile cardiovascular injuries since Jan 1996 to Oct 2008 were studied retrospectively. All patients of cardiovascular injuries due to causes other than missiles were excluded from the study.
All patients of missile cardiac injuries were treated by primary cardiorrhaphy. Right ventricle was the most commonly affected chamber. Left anterior thoracotomy was most common approach used. Most of the patients of missile vascular group were treated by reverse saphenous vein graft or end-to-end anastomosis. Most common complication was wound infection (20.83%) followed by graft occlusion (1.94%) in missile vascular group. Amputation rate was 4.66%. Amputation rate was higher in patients with delay of >6 hours and associated fractures.
Missile cardiac injuries should be operated early without wasting time for investigations. Clinical status at arrival, time interval till management, nature of injury and associated injuries, tell upon the mortality. Missile vascular injury needs prompt resuscitation and revascularization at the earliest. Time interval till revascularization and associated fractures has a bearing on mortality and morbidity.
自1990年武装冲突爆发以来，克什米尔山谷地区的导弹所致心血管损伤呈流行态势。本研究旨在分析导弹所致心血管损伤的类型、表现及治疗方法。
回顾性研究了1996年1月至2008年10月期间386例导弹所致心血管损伤患者。本研究排除了所有因非导弹原因导致心血管损伤的患者。
所有导弹所致心脏损伤患者均接受了一期心脏缝合术。右心室是最常受累的腔室。最常用的手术入路是左前开胸术。导弹所致血管损伤组的大多数患者接受了大隐静脉反向移植术或端端吻合术。最常见的并发症是伤口感染（20.83%），其次是导弹所致血管损伤组的移植物闭塞（1.94%）。截肢率为4.66%。延迟时间>6小时且伴有骨折的患者截肢率更高。
导弹所致心脏损伤应尽早手术，无需浪费时间进行检查。入院时的临床状况、至治疗的时间间隔、损伤性质及合并伤均与死亡率相关。导弹所致血管损伤需要尽早进行迅速复苏和血管重建。至血管重建的时间间隔及合并骨折与死亡率和发病率相关。
