Breaux E P, Dupont J B, Albert H M, Bryant L R, Schechter F G
J Trauma. 1979 Jun;19(6):461-6. doi: 10.1097/00005373-197906000-00008.
Cardiac tamponade was diagnosed in 197 patients admitted over 20 years (1955-1974) to the Charity Hospital of New Orleans, for emergency treatment of pentrating mediastinal injuries. Of the 197, 174 definitively treated patients followed one of three patterns of management: 96 had OR thoracotomy, 68% were unstable, and preoperative pericardiocentesis reduced mortality from 25 to 11% (p less than 0.01); 44 had emergency thoracotomy, 91% were unstable, and prethoractomy pericardiocentesis decreased mortality from 94 to 63% (p less than 0.05); 34 patients primarily with isolated stab wounds, were treated nonsurgically with pericardiocentesis and observation, only 50% were unstable and there was 15% mortality. Recurrent tamponade did not significantly increase overall or operative mortality in patients with pericardiocentesis.
early, even presumptive, diagnosis of tamponade; immediate pericardial decompression via pericardiocentesis; and rapid transfer to OR for thoracotomy or sternotomy and cardiorrhaphy with continous pericardial decompression via intrapericardial catheter.
在20年期间（1955 - 1974年），新奥尔良慈善医院收治了197例因穿透性纵隔损伤而接受紧急治疗的患者，其中诊断为心脏压塞。在这197例患者中，174例接受了明确治疗的患者遵循了三种治疗模式之一：96例行开胸手术，68%病情不稳定，术前心包穿刺术使死亡率从25%降至11%（p < 0.01）；44例行急诊开胸手术，91%病情不稳定，术前开胸心包穿刺术使死亡率从94%降至63%（p < 0.05）；34例主要为孤立刺伤的患者，采用心包穿刺术和观察进行非手术治疗，仅50%病情不稳定，死亡率为15%。心包穿刺术患者复发性心脏压塞并未显著增加总体死亡率或手术死亡率。
早期，甚至是推测性的心脏压塞诊断；通过心包穿刺术立即进行心包减压；迅速转至手术室进行开胸手术或胸骨切开术，并通过心包内导管持续心包减压进行心脏修补术。
