Maenza R L, Seaberg D, D'Amico F
University of Pittsburgh Affiliated Residency in Emergency Medicine, Mercy Hospital of Pittsburgh, USA.
Am J Emerg Med. 1996 May;14(3):237-41. doi: 10.1016/S0735-6757(96)90165-5.
The purpose of this study was to use a meta-analysis of the current literature to identify which patients with blunt cardiac trauma develop complications. All studies on myocardial contusion since 1967 were reviewed. Three separate meta-analyses were performed: one with only prospective studies, one with only retrospective studies, and one with all studies combined. Data on electrocardiogram (ECG), creatine phosphokinase-MB isoenzyme (CPK-MB), radionuclide scans, and echocardiogram were analyzed using the Mantel-Haenszel procedure. Results of the three meta-analyses were similar. Abnormal ECG and abnormal CPK-MB were found to correlate directly with complications requiring treatment. Conversely, normal ECG and CPK-MB correlated with the lack of clinically significant complications. Radionuclide scans did not correlate with complications. The results for echocardiogram were not congruent between the prospective and retrospective studies. The data support the use of ECG and CPK-MB in the diagnosis of clinically significant myocardial contusion. Radionuclide scanning is not useful in the evaluation of patients with blunt cardiac trauma. Further studies need to define the role of echocardiography.
本研究的目的是通过对当前文献的荟萃分析，确定哪些钝性心脏创伤患者会出现并发症。对1967年以来所有关于心肌挫伤的研究进行了综述。进行了三项独立的荟萃分析：一项仅纳入前瞻性研究，一项仅纳入回顾性研究，一项纳入所有研究。使用Mantel-Haenszel方法分析了心电图（ECG）、肌酸磷酸激酶-MB同工酶（CPK-MB）、放射性核素扫描和超声心动图的数据。三项荟萃分析的结果相似。发现异常心电图和异常CPK-MB与需要治疗的并发症直接相关。相反，正常心电图和CPK-MB与无临床显著并发症相关。放射性核素扫描与并发症无关。前瞻性和回顾性研究中超声心动图的结果不一致。数据支持将心电图和CPK-MB用于诊断具有临床意义的心肌挫伤。放射性核素扫描对钝性心脏创伤患者的评估无用。需要进一步研究来确定超声心动图的作用。
