Mina Michael J, Jhunjhunwala Rashi, Gelbard Rondi B, Dougherty Stacy D, Carr Jacquelyn S, Dente Christopher J, Nicholas Jeffrey M, Wyrzykowski Amy D, Salomone Jeffrey P, Vercruysse Gary A, Feliciano David V, Morse Bryan C
Department of Surgery, Emory University School Medicine, Grady Memorial Hospital, Atlanta, GA, USA.
Department of Surgery, Gwinnett Medical Center, Lawrenceville, GA, USA.
Am J Surg. 2017 Jun;213(6):1109-1115. doi: 10.1016/j.amjsurg.2016.07.014. Epub 2016 Oct 15.
Despite the lethality of injuries to the heart, optimizing factors that impact mortality for victims that do survive to reach the hospital is critical.
From 2003 to 2012, prehospital data, injury characteristics, and clinical patient factors were analyzed for victims with penetrating cardiac injuries (PCIs) at an urban, level I trauma center.
Over the 10-year study, 80 PCI patients survived to reach the hospital. Of the 21 factors analyzed, prehospital cardiopulmonary resuscitation (odds ratio [OR] = 30), scene time greater than 10 minutes (OR = 58), resuscitative thoracotomy (OR = 19), and massive left hemothorax (OR = 15) had the greatest impact on mortality. Cardiac tamponade physiology demonstrated a "protective" effect for survivors to the hospital (OR = .08).
Trauma surgeons can improve mortality after PCI by minimizing time to the operating room for early control of hemorrhage. In PCI patients, tamponade may provide a physiologic advantage (lower mortality) compared to exsanguination.
尽管心脏损伤具有致命性，但对于那些存活至医院的受害者，优化影响死亡率的因素至关重要。
2003年至2012年期间，对一家城市一级创伤中心的穿透性心脏损伤（PCI）受害者的院前数据、损伤特征和临床患者因素进行了分析。
在为期10年的研究中，80例PCI患者存活至医院。在分析的21个因素中，院前心肺复苏（比值比[OR]=30）、现场时间超过10分钟（OR=58）、复苏性开胸手术（OR=19）和大量左侧血胸（OR=15）对死亡率影响最大。心包填塞生理状态对存活至医院的患者显示出“保护”作用（OR=0.08）。
创伤外科医生可通过尽量缩短进入手术室的时间以尽早控制出血，来提高PCI后的生存率。在PCI患者中，与失血相比，心包填塞可能具有生理优势（较低的死亡率）。
