McFarlane M, Branday J M
Department of Surgery, U.W.I., Jamaica.
West Indian Med J. 1990 Jun;39(2):74-9.
This study represents a review of 33 patients seen at the Kingston Public Hospital, Jamaica, with penetrating cardiac injuries over a 7-year period from 1982 to 1989. Male patients between the ages of 12 and 30 years accounted for more than 80 per cent of cases. A history of syncope associated with haemodynamic instability were the predominant clinical features on presentation. The clinical triad of raised central venous pressure, muffled heart sounds, and low blood pressure levels was present in 33 per cent of the patients with cardiac tamponade. Pulsus paradoxus was not a significant diagnostic sign. Most of the injuries were stab wounds to the left anterior chest. The most commonly injured heart chamber was the right ventricle (48 per cent). Pericardiocentesis was not helpful in making the diagnosis and was only performed as a resuscitative measure in unstable patients prior to thoracotomy. Cardiorrhaphy was performed in the majority of patients through a left anterior lateral thoracotomy with median sternotomy being used only for suspected hilar injuries. A high index of suspicion in patients with penetrating thoracic trauma with expeditious thoracotomy will result in the greatest salvage rate.
本研究回顾了1982年至1989年7年间在牙买加金斯敦公立医院就诊的33例穿透性心脏损伤患者。年龄在12岁至30岁之间的男性患者占病例的80%以上。晕厥病史伴血流动力学不稳定是就诊时的主要临床特征。33%的心脏压塞患者出现中心静脉压升高、心音低钝和血压降低的临床三联征。奇脉不是一个重要的诊断体征。大多数损伤为左前胸刺伤。最常受伤的心脏腔室是右心室（48%）。心包穿刺术对诊断没有帮助，仅在不稳定患者开胸手术前作为复苏措施进行。大多数患者通过左前外侧开胸进行心脏缝合，仅在怀疑肺门损伤时采用正中胸骨切开术。对穿透性胸部创伤患者保持高度怀疑并迅速进行开胸手术将获得最高的挽救率。
