Karalis D G, Victor M F, Davis G A, McAllister M P, Covalesky V A, Ross J J, Foley R V, Kerstein M D, Chandrasekaran K
Department of Cardiology, Hahnemann University Hospital, Philadelphia, PA 19102.
J Trauma. 1994 Jan;36(1):53-8. doi: 10.1097/00005373-199401000-00008.
Previous studies assessing the value of transthoracic echocardiography (TTE) in blunt chest trauma are limited because patients with severe chest wall injury often have suboptimal echocardiographic findings. Transesophageal echocardiography (TEE) can provide high quality images when the transthoracic image quality is poor. To provide complete echocardiographic assessment of cardiac structure and function we prospectively performed TTE in 105 patients with severe blunt chest trauma and TEE in 20 of the 105 patients (19%) whose TTE examination results were suboptimal. Myocardial contusion was diagnosed in 31 patients (30%), 22 by TTE and nine by TEE. Cardiac complications developed in 8 of 31 patients (26%) with myocardial contusion compared with 2 of 74 patients (3%) with normal echocardiographic findings (p = 0.001). Cardiac complications required treatment in only four patients. Echocardiography was of value in detecting severe right ventricular dysfunction as the cause of hypotension in two patients with suspected cardiac tamponade. Four patients with myocardial contusion died compared with two patients with normal echocardiographic findings (p = NS). No death was related to the cardiac status. In addition, TEE detected aortic injury in five patients, four with focal intimal tears and one with an aortic transection. We conclude that myocardial contusion is common following blunt chest trauma, rarely requires treatment, and is associated with a favorable prognosis. Only patients who develop cardiac complications benefit from echocardiography. Transesophageal echocardiography is of value when the TTE examination results are suboptimal and when aortic injury is suspected.
以往评估经胸超声心动图（TTE）在钝性胸部创伤中价值的研究有限，因为严重胸壁损伤患者的超声心动图检查结果往往欠佳。当经胸图像质量较差时，经食管超声心动图（TEE）能够提供高质量图像。为了对心脏结构和功能进行完整的超声心动图评估，我们前瞻性地对105例严重钝性胸部创伤患者进行了TTE检查，并对其中20例（19%）TTE检查结果欠佳的患者进行了TEE检查。31例患者（30%）被诊断为心肌挫伤，其中22例通过TTE诊断，9例通过TEE诊断。31例心肌挫伤患者中有8例（26%）发生心脏并发症，而超声心动图检查结果正常的74例患者中有2例（3%）发生心脏并发症（p = 0.001）。只有4例心脏并发症患者需要治疗。超声心动图对于检测2例疑似心脏压塞患者中导致低血压的严重右心室功能障碍具有重要价值。4例心肌挫伤患者死亡，而超声心动图检查结果正常的患者中有2例死亡（p = 无显著性差异）。没有死亡与心脏状况相关。此外，TEE检测到5例主动脉损伤，其中4例为局灶性内膜撕裂，1例为主动脉横断。我们得出结论，钝性胸部创伤后心肌挫伤很常见，很少需要治疗，且预后良好。只有发生心脏并发症的患者才能从超声心动图检查中获益。当TTE检查结果欠佳以及怀疑有主动脉损伤时，经食管超声心动图具有重要价值。
