Karrel R, Shaffer M A, Franaszek J B
Ann Emerg Med. 1982 Sep;11(9):504-17. doi: 10.1016/s0196-0644(82)80073-5.
The controversy concerning the mode of resuscitation in acute penetrating cardiac trauma has been resolved in recent years. Most large centers are aggressive, and pericardiocentesis is used in life-threatening situations only as a temporary measure until thoracotomy can be performed. There are at least 32 publications which recommended emergency department thoracotomy for resuscitation of the critically injured heart. The physician should be alerted when patients arrive with penetrating chest and upper abdominal wounds. Cardiac injury must be ruled out as soon as possible, for minutes may mean the difference between successful resuscitation and irreversible myocardial damage. Most penetrating chest wounds are easily managed in the emergency department with fluid resuscitation and chest tube drainage. Patients who have an isolated penetrating cardiac injury will have the best prognosis; moribund patients who are suffering from extrathoracic injuries, especially CNS injuries, will have a dismal prognosis. The keys to successful resuscitation of the traumatized heart are a high index of suspicion, early recognition, and rapid intervention.
近年来，关于急性穿透性心脏创伤复苏方式的争议已得到解决。大多数大型中心采取积极的措施，心包穿刺仅在危及生命的情况下作为临时措施使用，直到能够进行开胸手术。至少有32篇出版物推荐在急诊科进行开胸手术以复苏严重受伤的心脏。当患者因胸部和上腹部穿透伤前来就诊时，医生应提高警惕。必须尽快排除心脏损伤，因为几分钟的时间可能意味着复苏成功与不可逆心肌损伤之间的差异。大多数穿透性胸部伤口在急诊科通过液体复苏和胸腔闭式引流很容易处理。单纯性穿透性心脏损伤的患者预后最佳；患有胸外损伤尤其是中枢神经系统损伤的濒死患者预后不佳。成功复苏受创伤心脏的关键是高度的怀疑指数、早期识别和快速干预。
