Biffl W L, Moore F A, Moore E E, Sauaia A, Read R A, Burch J M
Department of Surgery, Denver General Hospital, Colorado 80204-4507.
Am J Surg. 1994 Dec;168(6):523-7; discussion 527-8. doi: 10.1016/s0002-9610(05)80115-1.
Myocardial contusion is commonly diagnosed following blunt chest trauma, and has potentially lethal complications. Cost-effective case management in patients with suspected myocardial contusion is confounded by the low incidence of complications and the lack of a reliable test to predict them. The clinical usefulness of elevated cardiac enzyme levels is controversial.
We analyzed a 4-year experience of 359 patients with high-risk blunt chest trauma who were assessed using an established practice guideline. Our multivariate statistical model evaluated all of the early risk factors included in the guideline, specifically focusing on cardiac enzyme levels.
Myocardial contusion was diagnosed in 30% of patients, and complications (dysrhythmias and cardiogenic shock) occurred in 5%. In no case was cardiac enzyme elevation the sole predictor of a complication. The cost of routine cardiac enzyme assay was substantial.
Cardiac enzyme determinations have no useful role in the evaluation of patients with suspected myocardial contusion. They should be eliminated from current practice guidelines.
心肌挫伤通常在钝性胸部创伤后被诊断出来，并且有潜在的致命并发症。疑似心肌挫伤患者的经济有效病例管理因并发症发生率低以及缺乏可靠的预测检测方法而受到困扰。心脏酶水平升高的临床实用性存在争议。
我们分析了359例高危钝性胸部创伤患者4年的经验，这些患者是根据既定的实践指南进行评估的。我们的多变量统计模型评估了指南中包括的所有早期危险因素，特别关注心脏酶水平。
30%的患者被诊断为心肌挫伤，5%的患者出现并发症（心律失常和心源性休克）。在任何情况下，心脏酶升高都不是并发症的唯一预测指标。常规心脏酶检测的成本很高。
心脏酶测定在疑似心肌挫伤患者的评估中没有有用的作用。它们应从当前的实践指南中删除。
