Division of Trauma and Surgical Critical Care, Department of Surgery, Kendall Regional Medical Center, Miami, Florida.
Division of Trauma and Surgical Critical Care, Department of Surgery, Kendall Regional Medical Center, Miami, Florida; Department of Surgery, University of South Florida, Tampa, Florida.
J Surg Res. 2022 Aug;276:120-135. doi: 10.1016/j.jss.2022.02.018. Epub 2022 Mar 24.
Penetrating cardiac injuries (PCIs) have high in-hospital mortality rates. Guidelines regarding the use of pericardial window (PW) for diagnosis and treatment of suspected PCIs are not universally established. The objective of this review was to provide a critical appraisal of the current literature to determine the effectiveness and safety of PW as both a diagnostic and therapeutic technique for suspected PCIs in patients with hemodynamic stability.
A review was conducted using PubMed/MEDLINE, Google Scholar, and Embase to identify literature evaluating the accuracy and therapeutic efficacy of PW and its role in a hemodynamically stable patient with penetrating thoracic or thoracoabdominal trauma.
Eleven studies evaluating diagnostic PW and two studies evaluating therapeutic PW were included. These studies ranged from (y) 1977 to 2018. Existing literature indicates that PW is highly sensitive (92%-100%) and specific (96%-100%) for the diagnosis of suspected PCIs. PW and drainage, when compared with sternotomy, may be associated with decreased total hospital stay (4.1 versus 6.5 d; P < 0.001) and intensive care unit stay (0.25 versus 2.04 d; P < 0.001) along with similar mortality and complication rates after the management of hemopericardium.
In a hemodynamically stable patient presenting with penetrating cardiac trauma with a high suspicion for PCI, PWs can (1) facilitate prompt diagnosis in the event of equivocal ultrasonography findings and (2) serve as an effective therapeutic modality with the benefit of potentially avoiding more invasive procedures. Subxiphoid, transdiaphragmatic, and laparoscopic approaches for PW have been shown to have similar efficacy and safety.
穿透性心脏损伤（PCIs）的院内死亡率很高。关于心包开窗术（PW）用于诊断和治疗疑似 PCI 的指南尚未得到普遍确立。本综述的目的是批判性地评估当前文献，以确定 PW 作为诊断和治疗稳定血流动力学患者疑似 PCI 的有效性和安全性。
使用 PubMed/MEDLINE、Google Scholar 和 Embase 进行综述，以确定评估 PW 的准确性和治疗效果及其在血流动力学稳定的穿透性胸部或胸腹创伤患者中的作用的文献。
纳入了 11 项评估诊断性 PW 的研究和 2 项评估治疗性 PW 的研究。这些研究的时间范围从（y）1977 年至 2018 年。现有文献表明，PW 对疑似 PCI 的诊断具有高度的敏感性（92%-100%）和特异性（96%-100%）。与开胸术相比，PW 和引流可能与总住院时间（4.1 天与 6.5 天；P<0.001）和 ICU 住院时间（0.25 天与 2.04 天；P<0.001）缩短有关，同时在处理血心包后死亡率和并发症发生率相似。
在血流动力学稳定的穿透性心脏创伤患者中，高度怀疑 PCI 时，PW 可以（1）在超声检查结果不确定时有助于快速诊断，（2）作为一种有效的治疗方式，有可能避免更具侵袭性的手术。经剑突下、经横膈膜和腹腔镜 PW 方法已被证明具有相似的疗效和安全性。
