Fulda G, Rodriguez A, Turney S Z, Cowley R A
Maryland Institute for Emergency Medical Services Systems, Baltimore.
J Cardiovasc Surg (Torino). 1990 Jul-Aug;31(4):525-30.
Blunt traumatic pericardial rupture is rarely diagnosed preoperatively and is associated with high mortality. During a ten-year period from 1979 to 1989 over 20,000 patients were admitted to a major trauma center and 22 were found to have blunt traumatic pericardial rupture. Sixteen of the 22 (72.7%) were injured in vehicle accidents, 3 (13.6%) in motorcycle crashes, and 2 (9.1%) in falls; 1 (4.5%) was crushed. Eighteen (81.8%) were diagnosed intraoperatively during resuscitation or surgery for associated injuries, and four (18.1%) were diagnosed preoperatively with pericardial window. Eighteen were males and four were females. The median age was 40.14 years (range, 17 to 68). The tears were found at the following sites: left pleuropericardial (14/22 [64%]), diaphragmatic (4/22 [18%]), right pleuropericardial (2/22 [9%]), and superior mediastinal (2/22 [9%]). Associated cardiac injuries were found in only 5 of the 22 (22.7%); all of those patients died. The overall mortality rate was 63.6% (14/22). A high index of suspicion should alert the trauma surgeon to make the diagnosis intraoperatively during emergency surgical resuscitation in the hemodynamically unstable patient and by pericardial window in the stable patient.
钝性创伤性心包破裂术前很少被诊断出来，且死亡率很高。在1979年至1989年的十年间，超过20000名患者被收治于一家大型创伤中心，其中22例被发现有钝性创伤性心包破裂。22例中的16例（72.7%）在车祸中受伤，3例（13.6%）在摩托车事故中受伤，2例（9.1%）在跌倒时受伤；1例（4.5%）被挤压伤。18例（81.8%）在复苏或手术治疗相关损伤时术中被诊断出来，4例（18.1%）术前通过心包开窗术被诊断出来。18例为男性，4例为女性。中位年龄为40.14岁（范围17至68岁）。撕裂部位如下：左胸膜心包（14/22 [64%]）、膈面（4/22 [18%]）、右胸膜心包（2/22 [9%]）和上纵隔（2/22 [9%]）。22例中只有5例（22.7%）发现有相关心脏损伤；所有这些患者均死亡。总体死亡率为63.6%（14/22）。高度的怀疑指数应提醒创伤外科医生，对于血流动力学不稳定的患者，在紧急手术复苏过程中进行术中诊断；对于病情稳定的患者，通过心包开窗术进行诊断。
