Demetriades D, Charalambides D, Pantanowitz D, Lakhoo M
Department of Surgery, Baragwanath Hospital, Johannesburg, Republic of South Africa.
Arch Surg. 1990 Sep;125(9):1187-9. doi: 10.1001/archsurg.1990.01410210113018.
The presence of pneumopericardium following penetrating injuries of the chest is highly suggestive of a cardiac injury. For this reason, it is generally considered that its presence should be an indication for surgery. In the present study 20 patients with pneumopericardium were selected for conservative treatment. All patients were closely observed by means of clinical examination, serial chest roentgenography, electrocardiography, and Doppler echocardiography. In five patients the electrocardiogram showed pericarditis, and in three patients the echocardiogram demonstrated small pericardial effusions. One patient developed tension pneumopericardium 36 hours after admission and required surgical intervention. The remaining 19 patients had an uneventful recovery. We suggest that the presence of a pneumopericardium following penetrating chest trauma is not an absolute indication for surgery. Electrocardiographic and echographic studies may help in the selection of patients for conservative treatment; but the final decision should be made on the basis of clinical signs and symptoms.
胸部穿透伤后出现心包积气高度提示心脏损伤。因此，一般认为心包积气的存在应作为手术指征。在本研究中，选择了20例有心包积气的患者进行保守治疗。所有患者均通过临床检查、系列胸部X线检查、心电图和多普勒超声心动图进行密切观察。5例患者心电图显示心包炎，3例患者超声心动图显示少量心包积液。1例患者入院36小时后发生张力性心包积气，需要手术干预。其余19例患者恢复顺利。我们认为，胸部穿透伤后心包积气的存在并非手术的绝对指征。心电图和超声检查有助于选择保守治疗的患者；但最终决定应基于临床体征和症状做出。
