Aaland M O, Bryan F C, Sherman R
Department of Surgery, University of Illinois College of Medicine at Peoria 61603.
Am Surg. 1994 Jun;60(6):412-5.
Hemodynamically stable patients with penetrating precordial trauma present a diagnostic dilemma. Previous reports utilizing subxiphoid pericardial windows as the diagnostic measure demonstrated negative rates ranging from 75-82%. In an effort to decrease the high rate of negative invasive procedures, the following study was undertaken.
All hemodynamically stable victims with penetrating precordial trauma were evaluated using emergent echocardiogram over a one year period at Grady Memorial Hospital. If the echocardiogram was negative for the presence of pericardial fluid, the patient was observed for 24 hours. If pericardial fluid was detected, the patient underwent a subxiphoid pericardial window. Patients requiring immediate surgery for other reasons, i.e. peritonitis, underwent a pericardial window during the procedure without preoperative echocardiogram.
Fifty-three patients were entered into the study. The injuries sustained included 40 stab wounds, 11 gunshot wounds and 2 shotgun injuries. Two echocardiograms (8%) demonstrated > 20cc of fluid and were followed by pericardial windows. The remaining 51 patients did well without the need for pericardial window. Nine additional hemodynamically stable patients underwent pericardial windows without preoperative echocardiograms. Only one of these was positive with a cardiac injury proven at sternotomy.
Echocardiogram is a sensitive noninvasive method of evaluating hemodynamically stable victims of penetrating chest wounds in proximity to the heart.
血流动力学稳定的前胸部穿透伤患者存在诊断难题。既往利用剑突下心包开窗术作为诊断手段的报告显示，阴性率在75%至82%之间。为降低侵入性检查的高阴性率，开展了以下研究。
在格雷迪纪念医院，对所有血流动力学稳定的前胸部穿透伤患者在一年时间内进行急诊超声心动图检查。如果超声心动图显示心包积液为阴性，则对患者观察24小时。如果检测到心包积液，则患者接受剑突下心包开窗术。因其他原因（如腹膜炎）需要立即手术的患者，在手术过程中进行心包开窗术，术前不做超声心动图检查。
53例患者纳入研究。受伤类型包括40例刺伤、11例枪伤和2例霰弹枪伤。2例超声心动图（8%）显示积液>20cc，随后进行了心包开窗术。其余51例患者情况良好，无需进行心包开窗术。另外9例血流动力学稳定的患者在未做术前超声心动图检查的情况下接受了心包开窗术。其中只有1例为阳性，在胸骨切开术中证实有心脏损伤。
超声心动图是评估血流动力学稳定的心脏附近胸部穿透伤患者的一种敏感的非侵入性方法。
