Parreira José Gustavo, Coimbra Raul
From the Emergency Surgical Services, Department of Surgery (J.G.P.), Santa Casa School of Medicine, Sao Paulo, Brazil; Division of Acute Care Surgery (R.C.), and Comparative Effectiveness and Clinical Outcomes Research Center (R.C.), Riverside University Health System Medical Center, Moreno Valley; and Loma Linda University School of Medicine (R.C.), Loma Linda, California.
J Trauma Acute Care Surg. 2025 Apr 1;98(4):523-532. doi: 10.1097/TA.0000000000004524. Epub 2024 Dec 10.
Despite significant advances in trauma surgery in recent years, patients sustaining penetrating cardiac injuries still have an overall survival rate of 19%. A substantial number of deaths occur at the scene, while approximately 40% of those reaching trauma centers survive. To increase survival, the key factor is timely intervention for bleeding control, pericardial tamponade release, and definitive repair. Asymptomatic patients sustaining precordial wounds or mediastinal gunshot wounds should be assessed with chest ultrasound to rule out cardiac injuries. Shock on admission is an immediate indication of surgery repair. Patients admitted in posttraumatic cardiac arrest may benefit from resuscitative thoracotomy. The surgical team must be assured that appropriate personnel, equipment, instruments, and blood are immediately available in the operating room. A left anterolateral thoracotomy, which can be extended to a clamshell incision, and sternotomy are the most common surgical incisions. Identification of cardiac anatomical landmarks during surgery is vital to avoid complications. There are several technical options for bleeding control, and the surgeon must be trained to use them to obtain optimal results. Ultimately, prioritizing surgical intervention and using effective resuscitation strategies are essential for improving survival rates and outcomes.
尽管近年来创伤外科取得了重大进展，但遭受穿透性心脏损伤的患者总体生存率仍为19%。相当一部分患者在现场死亡，而到达创伤中心的患者中约40%存活。为提高生存率，关键因素是及时进行干预以控制出血、解除心包填塞并进行确定性修复。对于有胸前区伤口或纵隔枪伤的无症状患者，应进行胸部超声检查以排除心脏损伤。入院时休克是手术修复的直接指征。创伤后心脏骤停入院的患者可能受益于复苏性开胸手术。手术团队必须确保手术室中立即有合适的人员、设备、器械和血液。左前外侧开胸术（可扩展为蛤壳状切口）和胸骨切开术是最常见的手术切口。手术过程中识别心脏解剖标志对于避免并发症至关重要。控制出血有多种技术选择，外科医生必须接受培训以使用这些技术来获得最佳效果。最终，优先进行手术干预并采用有效的复苏策略对于提高生存率和改善预后至关重要。
