Department of Surgery, University of Tennessee Health Science Center-Memphis, Memphis, TN, USA.
Am Surg. 2023 Jul;89(7):3110-3113. doi: 10.1177/00031348231157815. Epub 2023 Feb 22.
Management of penetrating chest injuries with a positive pericardial window (PW) are presumed cardiac injuries and traditionally result in sternotomy. However, there is some evidence in the literature that select patients can be managed with PW, lavage, and drainage (PWLD).
All patients with penetrating chest trauma who underwent PW and/or sternotomy over a 5-year period were identified. Patients were stratified by operative intervention [PW + sternotomy vs PWLD] and compared. Multivariable logistic regression (MLR) analysis was performed to determine independent predictors of therapeutic sternotomy.
Of the 146 patients who underwent PW and/or sternotomy included in the study, 126 patients underwent PW, 39 underwent sternotomy, and 10 underwent PWLD. There was no difference in demographics, LOS, ICU LOS, vent days, or mortality in patients who underwent PW + sternotomy, compared to patients who underwent PWLD. In the PWLD group, one patient returned to the OR for recurrent pericardial effusion and no patients required sternotomy. Multivariable logistic regression identified ISS as an independent predictor of therapeutic sternotomy (OR 1.160; 95% CI 1.006-1.338, P = .0616). Interestingly, positive FAST, significant CT findings, and trajectory were not predictors of therapeutic sternotomy. There were 7 patients with a left hemothorax and negative FAST found to have a positive PW and cardiac injury mandating sternotomy and repair.
Penetrating cardiac injury can be managed with PWLD in select patients. Positive FAST, significant findings on CT, and trajectory do not mandate sternotomy. A negative FAST in the setting of a hemothorax does not rule out a cardiac injury.
具有正性心包窗（PW）的穿透性胸部损伤的处理被认为是心脏损伤，传统上需要进行正中开胸术。然而，文献中有一些证据表明，选择合适的患者可以通过 PW、灌洗和引流（PWLD）进行治疗。
确定了在 5 年内接受 PW 和/或正中开胸术的所有穿透性胸部创伤患者。根据手术干预措施（PW + 正中开胸术与 PWLD）对患者进行分层，并进行比较。采用多变量逻辑回归（MLR）分析确定治疗性正中开胸术的独立预测因素。
在研究中纳入的 146 例接受 PW 和/或正中开胸术的患者中，126 例接受 PW，39 例接受正中开胸术，10 例接受 PWLD。与接受 PWLD 的患者相比，接受 PW + 正中开胸术的患者在人口统计学、 LOS、ICU LOS、通气天数或死亡率方面没有差异。在 PWLD 组中，1 例患者因复发性心包积液返回手术室，无患者需要正中开胸术。多变量逻辑回归确定 ISS 是治疗性正中开胸术的独立预测因素（OR 1.160；95%CI 1.006-1.338，P =.0616）。有趣的是，阳性 FAST、显著的 CT 发现和弹道都不是治疗性正中开胸术的预测因素。有 7 例左侧血胸患者 FAST 为阴性，但 PW 阳性且存在心脏损伤，需要正中开胸术和修复。
在选择合适的患者中，可以通过 PWLD 治疗穿透性心脏损伤。阳性 FAST、CT 上的显著发现和弹道并不需要正中开胸术。在血胸的情况下，阴性 FAST 并不能排除心脏损伤。
