Smith M D, Cassidy J M, Souther S, Morris E J, Sapin P M, Johnson S B, Kearney P A
Department of Internal Medicine, University of Kentucky Medical Center, Lexington 40536-0084.
N Engl J Med. 1995 Feb 9;332(6):356-62. doi: 10.1056/NEJM199502093320603.
Rupture of the aorta is a major cause of death after motor vehicle accidents. Survival depends on early diagnosis, and emergency aortography is the standard imaging method. Although transesophageal echocardiography is noninvasive and can provide high-resolution images of the aorta, information about its value in patients with trauma is limited. We conducted this study to assess prospectively the value of transesophageal echocardiography in the emergency evaluation of patients at risk for aortic injury.
Transesophageal echocardiography of the aorta was attempted in 101 patients admitted to the emergency room with a diagnosis of possible traumatic rupture of the aorta. Echocardiography and aortography personnel were notified simultaneously of the arrival of the patient, and the two tests were performed sequentially by operators who were blinded to the results of the other test. The sensitivity and specificity of transesophageal echocardiography were calculated on the basis of the results of aortography of the arch, surgery, or autopsy.
Transesophageal echocardiography was attempted in 101 patients. The study was successfully performed in 93 patients but could not be completed in 8 because of lack of cooperation on the part of the patient (7 patients) or maxillofacial trauma (1 patient). Despite a high injury-severity score (mean, 29.6), transesophageal echocardiography was performed without complications, and within a mean (+/- SD) of 29 +/- 12 minutes. Eleven of the 93 studies (12 percent) demonstrated rupture of the aorta near the isthmus. The findings were confirmed in 10 of the 11 patients by aortography (9 patients), surgery (9 patients), or autopsy (1 patient), yielding a sensitivity of 100 percent and specificity of 98 percent for the detection of injury to the aorta. There was one false positive echocardiogram.
Transesophageal echocardiography is a highly sensitive and specific method of detecting injury to the thoracic aorta. This technique can be used safely and quickly in critically injured patients with suspected traumatic rupture of the aorta and compares favorably with arch aortography.
主动脉破裂是机动车事故后主要的死亡原因。存活与否取决于早期诊断，而急诊主动脉造影是标准的成像方法。尽管经食管超声心动图是非侵入性的，能够提供主动脉的高分辨率图像，但关于其在创伤患者中的价值的信息有限。我们进行这项研究以前瞻性评估经食管超声心动图在主动脉损伤风险患者的急诊评估中的价值。
对101名因可能的主动脉创伤性破裂而入住急诊室的患者尝试进行经食管主动脉超声心动图检查。当患者到达时，同时通知超声心动图和主动脉造影检查人员，两项检查由对另一项检查结果不知情的操作人员依次进行。根据主动脉弓造影、手术或尸检结果计算经食管超声心动图的敏感性和特异性。
对101名患者尝试进行经食管超声心动图检查。93名患者成功完成了该研究，但8名患者因患者不配合（7名患者）或颌面创伤（1名患者）而未能完成。尽管损伤严重程度评分较高（平均为29.6），经食管超声心动图检查仍无并发症发生，平均（±标准差）用时29±12分钟。93项研究中有11项（12%）显示主动脉峡部附近破裂。11名患者中的10名患者的检查结果通过主动脉造影（9名患者）、手术（9名患者）或尸检（1名患者）得到证实，检测主动脉损伤的敏感性为100%，特异性为98%。有1例假阳性超声心动图结果。
经食管超声心动图是检测胸主动脉损伤的一种高度敏感和特异的方法。该技术可安全、快速地用于疑似主动脉创伤性破裂的重症患者，与主动脉弓造影相比具有优势。
