Khang Tran Thuc
Department of Cardiovascular and Thoracic Surgery, Tam Anh Hospital, Ho Chi Minh City, Vietnam.
J Trauma Inj. 2024 Dec;37(4):268-275. doi: 10.20408/jti.2024.0063. Epub 2024 Dec 16.
The diagnosis and management of cardiac trauma and penetrating cardiac injuries pose significant challenges in emergency settings due to the rapid onset of life-threatening complications. This paper presents a narrative review to better describe the etiology, presentation, and management of penetrating cardiac trauma, offering insights and experiences related to performing emergency surgery for such cases.
We compiled cases of traumatic cardiac rupture and penetrating cardiac injuries accompanied by severe hemorrhagic shock that necessitated emergency surgery. Data were collected regarding the type of injury, causative agents, specific clinical features observed during emergency admission, intraoperative parameters, and treatment outcomes.
Twenty-one patients (16 men, 5 women) with cardiac rupture or penetrating cardiac injuries were recorded. All patients presented in severe shock, and six cases (28.6%) experienced cardiac arrest upon arrival in the operating room. Cardiac rupture due to blunt chest trauma occurred in two cases (9.5%), and one case (4.8%) involved right atrial perforation due to complex open chest trauma. Penetrating injuries accounted for cardiac perforation in 18 cases (85.7%). Associated injuries were present in 11 cases (52.4%). The intraoperative mortality rate was 9.5%, and there was one postoperative death on the 11th day due to multiorgan failure.
Cardiac trauma and penetrating injuries are usually fatal unless promptly diagnosed and surgically treated. The timing and rapidity of emergency surgery-often foregoing ancillary tests and administrative procedures-are critical for patient survival. Emergency sternotomy, swift control of bleeding, and aggressive resuscitation are essential operative measures in saving lives. Factors that influence prognosis include the extent of blood loss, duration of cardiac arrest, acid-base imbalances, coagulopathy, multiorgan failure, and postoperative infections.
由于危及生命的并发症迅速出现，心脏创伤和穿透性心脏损伤的诊断与处理在急诊情况下构成重大挑战。本文进行叙述性综述，以更好地描述穿透性心脏创伤的病因、表现及处理，提供与此类病例急诊手术相关的见解和经验。
我们收集了创伤性心脏破裂及穿透性心脏损伤合并严重失血性休克且需急诊手术的病例。收集了有关损伤类型、致病因素、急诊入院时观察到的具体临床特征、术中参数及治疗结果的数据。
记录了21例心脏破裂或穿透性心脏损伤患者（16例男性，5例女性）。所有患者均表现为严重休克，6例（28.6%）在进入手术室时发生心脏骤停。钝性胸部创伤导致的心脏破裂有2例（9.5%），1例（4.8%）因复杂开放性胸部创伤导致右心房穿孔。穿透伤导致心脏穿孔18例（85.7%）。11例（52.4%）存在合并伤。术中死亡率为9.5%，1例患者术后第11天因多器官功能衰竭死亡。
心脏创伤和穿透伤通常是致命的，除非能迅速诊断并进行手术治疗。急诊手术的时机和速度（通常省略辅助检查和行政程序）对患者存活至关重要。紧急胸骨切开术、迅速控制出血及积极复苏是挽救生命的关键手术措施。影响预后的因素包括失血量、心脏骤停持续时间、酸碱失衡、凝血功能障碍、多器官功能衰竭及术后感染。
