心脏盒穿透伤。

Penetrating injury to the cardiac box.

机构信息

From the Division of Trauma and Critical Care (J.S.K., K.I., L.A.D.L., C.R., D.D.), University of Southern California, Los Angeles, California; Department of Surgery (J.B.H.), The University of Texas Medical School at Houston, Houston, Texas; Anesthesiology and Critical Care Medicine Department (J.S.D.), Hospices Civils de Lyon, Lyon, France; and Department of Surgery (V.A.S.), Keck School of Medicine, University of Southern California, Los Angeles, California.

出版信息

J Trauma Acute Care Surg. 2020 Sep;89(3):482-487. doi: 10.1097/TA.0000000000002808.

DOI:10.1097/TA.0000000000002808

PMID:32467475

Abstract

BACKGROUND

A penetrating injury to the "cardiac box" is thought to be predictive of an injury to the heart; however, there is very little evidence available to support this association. This study aims to evaluate the relationship between penetrating trauma to the cardiac box and a clinically significant injury.

METHODS

All patients presenting to a Level I trauma center from January 2009 to June 2015 who sustained a penetrating injury isolated to the thorax were retrospectively identified. Patients were categorized according to the location of injury: within or outside the historical cardiac box. Patients with concurrent injuries both inside and outside the cardiac box were excluded. Clinical demographics, injuries, procedures, and outcomes were compared.

RESULTS

During this 7-year period, 330 patients (92% male; median age, 28 years) sustained penetrating injuries isolated to the thorax: 138 (42%) within the cardiac box and 192 (58%) outside the cardiac box. By mechanism, 105 (76%) were stab wounds (SW) and 33 (24%) were gunshot wounds (GSW) inside the cardiac box, and 125 (65%) SW and 67 (35%) GSW outside the cardiac box. The overall rate of thoracotomy or sternotomy (35/138 [25.4%] vs. 15/192 [7.8%], p < 0.001) and the incidence of cardiac injury (18/138 [13%] vs. 5/192 [2.6%], p < 0.001) were significantly higher in patients with penetrating trauma within the cardiac box. This was, however, dependent on mechanism with SW demonstrating a higher incidence of cardiac injury (15/105 [14.3%] vs. 3/125 [2.4%], p = 0.001) and GSW showing no significant difference (3/33 [9.1%] vs. 2/67 [3%], p = 0.328]. There was no difference in overall mortality (9/138 [6.5%] vs. 6/192 [3.1%], p = 0.144).

CONCLUSION

The role of the cardiac box in the clinical evaluation of a patient with a penetrating injury to the thorax has remained unclear. In this analysis, mechanism is important. Stab wounds to the cardiac box were associated with a higher risk of cardiac injury. However, for GSW, injury to the cardiac box was not associated with a higher incidence of injury. The diagnostic interaction between clinical examination and ultrasound, for the diagnosis of clinically significant cardiac injuries, warrants further investigation.

LEVEL OF EVIDENCE

Prognostic study, Level IV, Therapeutic V.

摘要

背景

穿透性“心胸盒”损伤被认为与心脏损伤有关；然而，几乎没有证据支持这种关联。本研究旨在评估穿透性心胸盒损伤与临床显著损伤之间的关系。

方法

回顾性分析 2009 年 1 月至 2015 年 6 月期间在一级创伤中心就诊的所有仅胸部穿透性损伤患者。根据损伤部位将患者分为：心胸盒内或心胸盒外。排除同时在心胸盒内外受伤的患者。比较临床人口统计学、损伤、程序和结果。

结果

在这 7 年期间，330 名（92%为男性；中位年龄 28 岁）患者仅胸部穿透性损伤：138 名（42%）位于心胸盒内，192 名（58%）位于心胸盒外。按机制，105 名（76%）为刀刺伤（SW），33 名（24%）为枪伤（GSW）位于心胸盒内，125 名（65%）SW 和 67 名（35%）GSW位于心胸盒外。心胸切开术或胸骨切开术（35/138 [25.4%] vs. 15/192 [7.8%]，p <0.001）和心脏损伤发生率（18/138 [13%] vs. 5/192 [2.6%]，p <0.001）在心胸盒内有穿透性创伤的患者中明显更高。然而，这取决于机制，SW 显示出更高的心脏损伤发生率（15/105 [14.3%] vs. 3/125 [2.4%]，p = 0.001），而 GSW 则无显著差异（3/33 [9.1%] vs. 2/67 [3%]，p = 0.328）。总体死亡率无差异（9/138 [6.5%] vs. 6/192 [3.1%]，p = 0.144）。