Nicol Andrew J, Navsaria Pradeep H
Trauma Centre, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Injury. 2014 Jan;45(1):112-5. doi: 10.1016/j.injury.2013.06.015. Epub 2013 Jul 12.
The aim of this study was to determine the sensitivity and specificity of a J wave on the electrocardiogram (ECG) to detect an occult cardiac injury in patients following penetrating chest trauma.
A prospective study conducted on patients admitted to the Groote Schuur Hospital Trauma Centre following penetrating chest trauma during the period of 1st October 2001 and 28th February 2009, who did not have an indication for emergency surgery and that underwent an ECG and later a subxiphoid pericardial window (SPW) for a potential cardiac injury. All the patients were easily resuscitatable with less than 2l of crystalloid. A standard 12-lead ECG was performed shortly after admission. A J wave was defined as the small positive reflection on the R-ST junction.
There were 174 patients where an ECG was performed and the patient underwent SPW for a possible cardiac injury. The mean age of the patients was 28 years (range 11-65). The mechanism of injury was stab wounds in 167 patients and 7 low velocity gunshot wounds. A J-wave was present on the ECG in 65 (37%) of the 174 patients with a possible cardiac injury. The sensitivity of a J wave to detect a hemopericardium was 44%, specificity was 85%, and positive predictive value of 91% (p<0.001).
The presence of a 'J' wave on ECG signifies a significant risk of an occult cardiac injury after penetrating thoracic trauma.
本研究的目的是确定心电图（ECG）上J波检测穿透性胸部创伤患者隐匿性心脏损伤的敏感性和特异性。
对2001年10月1日至2009年2月28日期间因穿透性胸部创伤入住格罗特舒尔医院创伤中心的患者进行前瞻性研究，这些患者没有急诊手术指征，接受了心电图检查，随后接受剑突下心包开窗术（SPW）以检查是否存在潜在的心脏损伤。所有患者使用少于2升晶体液即可轻松复苏。入院后不久进行标准12导联心电图检查。J波定义为R - ST段交界处的小正向波。
174例患者接受了心电图检查，并因可能的心脏损伤接受了SPW。患者的平均年龄为28岁（范围11 - 65岁）。损伤机制为刺伤167例，低速枪伤7例。174例可能存在心脏损伤的患者中，65例（37%）心电图上出现J波。J波检测心包积血的敏感性为44%，特异性为85%，阳性预测值为91%（p<0.001）。
心电图上出现“J”波表明穿透性胸部创伤后存在隐匿性心脏损伤的重大风险。
