Nakamura T, Tabuse H, Murao Y, Konobu T, Nishimura A, Miyamoto S
Department of Emergency and Critical Care Medicine, Nara Medical University, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1994 Aug;42(8):1242-6.
A 63-year-old man (case 1) was brought to our emergency unit following a high speed collision. He developed fatal cardiopulmonary arrest shortly after arrival despite resuscitation efforts. Tension pneumopericardium was revealed by chest X-ray and CT examination. An 18-year-old man (case 2) was admitted after a motorcycle accident. Pneumopericardium was noted on admission chest X-ray and CT examination. He developed cardiac tamponade after the examination. He was intubated and mechanically ventilated after the subxiphoid pericardial drainage. Pneumopericardium following blunt chest trauma is realized with tracheobronchial, pulmonary or esophageal injury. The clinical significance of pneumopericardium is the development of tension pneumopericardium resulting into cardiac tamponade. In a patient with traumatic pneumopericardium who requires mechanical ventilatory support, continuous pericardial drainage should be considered. In addition, tension pneumopericardium may occur in patients with breathing spontaneously as in our cases. In these cases, careful observation and immediate subxiphoid pericardial drainage are required.
一名63岁男性(病例1)在高速碰撞后被送至我院急诊科。尽管进行了复苏努力,但他在到达后不久就发生了致命的心肺骤停。胸部X线和CT检查显示为张力性心包积气。一名18岁男性(病例2)在摩托车事故后入院。入院时胸部X线和CT检查发现有心包积气。检查后他发生了心脏压塞。在剑突下心包引流后,他接受了气管插管和机械通气。钝性胸部创伤后的心包积气与气管支气管、肺或食管损伤有关。心包积气的临床意义在于发展为张力性心包积气导致心脏压塞。对于需要机械通气支持的创伤性心包积气患者,应考虑持续心包引流。此外,如我们的病例所示,张力性心包积气也可能发生在自主呼吸的患者中。在这些情况下,需要仔细观察并立即进行剑突下心包引流。