Raffy B, Lacour-Gayet F, Etienne J C, Fingerhut A, Jaouen D, Terville J P
Service de Réanimation Chirurgicale et SMUR, Centre Hospitalier Intercommunal, Poissy.
Ann Chir. 1993;47(2):132-5.
Traumatic rupture of the pericardium is a rare lesion usually associated with violent thoracic trauma and sudden deceleration. The case described herein is one of left intra-pleural luxation of the heart secondary to trauma which was asymptomatic for nine hours and was revealed by acute symptoms due to mobilisation of the patient. Diagnosis of this entity is difficult and is usually made in the acute multiple trauma setting. Although usually negative, lung films may be contributive; sonocardiogram, which should be obtained routinely in this setting, is often non-specific but usually provides the indication for thoracotomy. The most severe complication is extra-pericardic luxation of the heart with strangulation or volvulus, depending on the site and size of the pericardial tear. While all proven cases of pericardial rupture should be explored surgically, treatment varies for different teams according to the site and the size of the rupture.
创伤性心包破裂是一种罕见的损伤，通常与暴力胸部创伤和突然减速有关。本文所述病例为创伤后心脏左胸腔内脱位，9小时内无症状，因患者活动而出现急性症状。该病症的诊断困难，通常在急性多发伤情况下作出诊断。虽然胸部X光片通常为阴性，但可能有辅助作用；在此情况下应常规进行的超声心动图检查往往不具有特异性，但通常可为开胸手术提供指征。最严重的并发症是心脏心包外脱位，根据心包撕裂的部位和大小，可出现绞窄或扭转。虽然所有已证实的心包破裂病例均应进行手术探查，但不同团队根据破裂的部位和大小采取不同的治疗方法。
