Wisner D H, Reed W H, Riddick R S
Department of Surgery, University of California, Davis School of Medicine, California.
Ann Surg. 1990 Jul;212(1):82-6. doi: 10.1097/00000658-199007000-00011.
Although many different tests are used to diagnose myocardial contusion, the clinical implications of the diagnosis are unclear. This makes it difficult to decide which patients require admission to a monitored bed. During 16 months, 3010 patients with blunt trauma were reviewed for evidence of sequelae attributable to myocardial contusion. None of 2204 admissions to unmonitored beds had evidence of serious arrhythmias or heart failure. No patient who died after admission had myocardial contusion at autopsy. Of the 644 admissions to monitored beds, 95 had workups for suspected contusion. Heart failure not obvious on admission did not occur and there were only four arrhythmias that required treatment. Conduction abnormalities on admission electrocardiogram predicted serious arrhythmias. Echocardiography and creatine phosphokinase isoenzyme levels, although frequently positive, did not predict morbidity. Clinically significant myocardial contusions are rare. Patients who will develop life-threatening complications from blunt cardiac injury can be identified in an emergency room setting.
虽然有许多不同的检查用于诊断心肌挫伤，但该诊断的临床意义尚不清楚。这使得很难决定哪些患者需要入住监测病床。在16个月期间，对3010例钝性创伤患者进行了回顾，以寻找心肌挫伤后遗症的证据。2204例入住非监测病床的患者均无严重心律失常或心力衰竭的证据。入院后死亡的患者尸检时均无心肌挫伤。在644例入住监测病床的患者中，95例因疑似挫伤进行了检查。入院时不明显的心力衰竭未发生，仅4例心律失常需要治疗。入院心电图上的传导异常可预测严重心律失常。超声心动图和肌酸磷酸激酶同工酶水平虽然经常呈阳性，但不能预测发病率。具有临床意义的心肌挫伤很少见。在急诊室环境中可以识别出因钝性心脏损伤而将发生危及生命并发症的患者。
