Gervin A S, Fischer R P
J Trauma. 1982 Jun;22(6):443-8. doi: 10.1097/00005373-198206000-00001.
The impact on mortality of stabilization in the field before transport of patients with penetrating heart injuries is unknown. This retrospective study compares patients promptly transported with minimal therapy after penetrating cardiac injuries with such patients who had received prolonged attempts at stabilization in the field. During the period of study from 1979 to 1981 23 patients with penetrating wounds of the heart were seen at our institution. The overall mortality was 78%. Forty-three per cent of patients were not salvageable on the basis of extensive anatomic injury or excessive time delays before ambulance arrival. Fifty-six per cent were alive at the time of ambulance arrival with systolic blood pressures of greater than 90 mm Hg. All patients were injured within 10 minutes' rapid transport time from our institution. Approximately one half the patients were treated with 'scoop and run' technique with minimal in-field treatment. Delay from the arrival of the ambulance until definitive surgical correction was less than 9 minutes. The remaining patients were treated with extensive in-field attempts at stabilization with a delay of 25 minutes or more from ambulance arrival until definitive treatment (mean, 40 minutes). Patients with potentially salvageable injuries had a survival rate of 38%. In this group of patients, a salvage rate of 80% was achieved if transport delays were minimized. In contrast, no patients in whom field resuscitation with concomitant prolonged prehospital delay survived. These data suggest that prompt transport to the hospital without attempts at field resuscitation provides a better chance for survival among patients with penetrating heart wounds.
穿透性心脏损伤患者在转运前进行现场稳定处理对死亡率的影响尚不清楚。这项回顾性研究比较了穿透性心脏损伤后接受极少治疗并迅速转运的患者与在现场接受长时间稳定处理尝试的此类患者。在1979年至1981年的研究期间，我们机构共诊治了23例穿透性心脏伤口患者。总体死亡率为78%。43%的患者因广泛的解剖损伤或救护车到达前的时间延误过长而无法挽救。56%的患者在救护车到达时存活，收缩压大于90 mmHg。所有患者均在距我们机构10分钟快速转运时间内受伤。约一半患者采用“铲式搬运并迅速撤离”技术，现场治疗极少。从救护车到达至最终手术矫正的延迟时间少于9分钟。其余患者在现场进行了广泛的稳定处理尝试，从救护车到达至最终治疗的延迟时间为25分钟或更长（平均40分钟）。有潜在可挽救损伤的患者生存率为38%。在这组患者中，如果将转运延迟降至最低，挽救率可达80%。相比之下，在现场进行复苏且伴有长时间院前延迟的患者无一存活。这些数据表明，对于穿透性心脏伤口患者而言，不经现场复苏尝试而迅速转运至医院可提供更好的生存机会。
