Tang Andrew L, Inaba Kenji, Branco Bernardino C, Oliver Matthew, Bukur Marko, Salim Ali, Rhee Peter, Herrold Joseph, Demetriades Demetrios
Division of Trauma, Critical Care, and Emergency Surgery, University of Arizona, Tucson, USA.
Arch Surg. 2011 Sep;146(9):1061-6. doi: 10.1001/archsurg.2011.226.
A significant rate of postdischarge complications is associated with penetrating cardiac injuries.
Retrospective trauma registry review.
Level I trauma center.
All patients sustaining penetrating cardiac injuries between January 2000 and June 2010. Patient demographics, clinical data, operative findings, outpatient follow-up, echocardiogram results, and outcomes were extracted.
Cardiac-related complications and mortality.
During the 10.5-year study period, 406 of 40,706 trauma admissions (1.0%) sustained penetrating cardiac injury. One hundred nine (26.9%) survived to hospital discharge. The survivors were predominantly male (94.4%), with a mean (SD) age of 30.8 (11.7) years, and 74.3% sustained a stab wound. Signs of life were present on admission in 92.6%. Cardiac chambers involved were the right ventricle (45.9%), left ventricle (40.3%), right atrium (10.1%), left atrium (0.9%), and combined (2.8%). In-hospital follow-up was available for a mean (SD) of 11.0 (9.8) days (median, 8 days; range, 3-65 days) and outpatient follow-up was available in 46 patients (42.2%) for a mean (SD) of 1.9 (4.1) months (median, 0.9 months; range, 0.2-12 months). Abnormal echocardiograms demonstrated pericardial effusions (9), abnormal wall motion (8), decreased ejection fraction (<45%) (8), intramural thrombus (4), valve injury (4), cardiac enlargement (2), conduction abnormality (2), pseudoaneurysm (1), aneurysm (1), and septal defect (1). No operative intervention was required for the complications. The 1-year and 9-year survival rates were 97% and 88%, respectively.
Penetrating cardiac injuries remain highly lethal. A significant rate of cardiac complications can be expected and follow-up echocardiographic evaluation is warranted prior to discharge. The majority of these, however, can be managed without the need for surgical intervention.
出院后并发症的发生率与穿透性心脏损伤相关。
回顾性创伤登记审查。
一级创伤中心。
2000年1月至2010年6月期间所有遭受穿透性心脏损伤的患者。提取患者人口统计学资料、临床数据、手术发现、门诊随访、超声心动图结果及转归情况。
心脏相关并发症及死亡率。
在10.5年的研究期间，40706例创伤入院患者中有406例（1.0%）遭受穿透性心脏损伤。109例（26.9%）存活至出院。存活者以男性为主（94.4%），平均（标准差）年龄为30.8（11.7）岁，74.3%为刺伤。92.6%的患者入院时有生命体征。受累心腔为右心室（45.9%）、左心室（40.3%）、右心房（10.1%）、左心房（0.9%）及联合损伤（2.8%）。住院平均（标准差）随访11.0（9.8）天（中位数8天；范围3 - 65天），46例患者（42.2%）可进行门诊随访，平均（标准差）为1.9（4.1）个月（中位数0.9个月；范围0.2 - 12个月）。异常超声心动图表现为心包积液（9例）、室壁运动异常（8例）、射血分数降低（<45%）（8例）、壁内血栓形成（4例）、瓣膜损伤（4例）、心脏扩大（2例）、传导异常（2例）、假性动脉瘤（1例）、动脉瘤（1例）及室间隔缺损（1例）。并发症无需手术干预。1年和9年生存率分别为97%和88%。
穿透性心脏损伤仍然具有高度致死性。可预期有相当比例的心脏并发症，出院前需进行超声心动图评估。然而，其中大多数无需手术干预即可处理。
