Onan Burak, Demirhan Recep, Öz Kürşad, Onan Ismihan Selen
Department of Thoracic Surgery, Dr. Lütfi Kırdar Kartal Training And Research Hospital, İstanbul, Turkey.
Ulus Travma Acil Cerrahi Derg. 2011 Sep;17(5):423-9.
Cardiovascular injuries after trauma present with high mortality. The aim of the study was to present our experience in cardiac and great vessel injuries after chest trauma.
During the 10-year period, 104 patients with cardiac (n=94) and great vessel (n=10) injuries presented to our hospital. The demographic data, mechanism of injury, location of injury, other associated injuries, timing of surgical intervention, surgical approach, and clinical outcome were reviewed.
Eighty-eight (84.6%) males presented after chest trauma. The mean age of the patients was 32.5±8.2 years (range: 12-76). Penetrating injuries (62.5%) were the most common cause of trauma. Computed tomography was performed in most cases and echocardiography was used in some stable cases. Cardiac injuries mostly included the right ventricle (58.5%). Great vessel injuries involved the subclavian vein in 6, innominate vein in 1, vena cava in 1, and descending aorta in 2 patients. Early operations after admission to the emergency were performed in 75.9% of the patients. Thoracotomy was performed in 89.5% of the patients. Operative mortality was significantly high in penetrating injuries (p=0.01).
Clinicians should suspect cardiac and great vessel trauma in every patient presenting to the emergency unit after chest trauma. Computed tomography and echocardiography are beneficial in the management of chest trauma. Operative timing depends on hemodynamic status, and a multidisciplinary team approach improves the patient's prognosis.
创伤后心血管损伤死亡率高。本研究的目的是介绍我们在胸部创伤后心脏和大血管损伤方面的经验。
在10年期间，104例心脏（n = 94）和大血管（n = 10）损伤患者到我院就诊。回顾了人口统计学数据、损伤机制、损伤部位、其他相关损伤、手术干预时机、手术方式和临床结局。
88例（84.6%）男性在胸部创伤后就诊。患者的平均年龄为32.5±8.2岁（范围：12 - 76岁）。穿透伤（62.5%）是最常见的创伤原因。大多数病例进行了计算机断层扫描，一些稳定病例使用了超声心动图。心脏损伤主要包括右心室（58.5%）。大血管损伤中，6例累及锁骨下静脉，1例累及无名静脉，1例累及腔静脉，2例累及降主动脉。75.9%的患者在急诊入院后早期进行了手术。89.5%的患者进行了开胸手术。穿透伤的手术死亡率显著较高（p = 0.01）。
临床医生应对每例胸部创伤后到急诊科就诊的患者怀疑有心脏和大血管创伤。计算机断层扫描和超声心动图在胸部创伤的管理中有益。手术时机取决于血流动力学状态，多学科团队方法可改善患者预后。
