Buckman R F, Badellino M M, Mauro L H, Asensio J A, Caputo C, Gass J, Grosh J D
Department of Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania.
J Trauma. 1993 May;34(5):717-25; discussion 725-7. doi: 10.1097/00005373-199305000-00015.
A prospective study of 66 consecutive patients with cardiac wounds seen over a 27-month period is reported. No patient was excluded. Patients were stratified by injury mechanism and by physiologic scoring at admission using the cardiovascular-respiratory elements of the Trauma Score (CVRS). Admission cardiac rhythm was obtained in patients with a CVRS of 0 and a Glasgow Coma Scale (GCS) score of 3. Information concerning the anatomic extent of the cardiac wound, the presence or absence of tamponade, and the degree of injury to other structures was also collected prospectively. Seventy percent of the cardiac wounds were caused by gunshots. The probability of successful resuscitation was significantly related to mechanism of injury and physiologic condition on arrival. Among patients arriving with a CVRS of 0 and a GCS score of 3, survival correlated with cardiac rhythm. Pericardial tamponade did not prove to be an independent predictor of early survival. The presence of tamponade was statistically linked to the mechanism of injury. Transport by non-official conveyance was associated with a higher CVRS on arrival. Intoxication with alcohol or cocaine had no evident effect on resuscitation probability.
本文报道了一项前瞻性研究，该研究观察了在27个月期间连续收治的66例心脏创伤患者。无患者被排除。患者根据受伤机制以及入院时使用创伤评分（CVRS）的心血管呼吸要素进行生理评分分层。对CVRS为0且格拉斯哥昏迷量表（GCS）评分为3的患者记录入院时的心律。还前瞻性收集了有关心脏创伤的解剖范围、是否存在心包填塞以及其他结构的损伤程度的信息。70%的心脏创伤由枪击造成。成功复苏的可能性与受伤机制和到达时的生理状况显著相关。在CVRS为0且GCS评分为3的患者中，生存与心律相关。心包填塞并非早期生存的独立预测因素。心包填塞的存在与受伤机制在统计学上相关。乘坐非官方交通工具转运与到达时较高的CVRS相关。酒精或可卡因中毒对复苏概率无明显影响。
