Guenoun T, Hernot S, Nasser E, Debauchez M, Philip I, Desmonts J M
Département d'anesthésie-réanimation, hôpital Bichat, Paris, France.
Ann Fr Anesth Reanim. 1996;15(3):307-9. doi: 10.1016/s0750-7658(96)80010-4.
Penetrating cardiac injury has to be ruled out in any patients with penetrating thoracic injuries, even in those with no alterations in vital functions. Undelayed echocardiography should be performed to screen for the presence of pericardial effusion. The first case underlines the risk of cardiac tamponade if the diagnosis is missed. Echocardiography was not performed because no echocardiographist was present at the time, and a high suspicion of a neck vascular injury existed. Sudden deterioration due to the onset of acute tamponade was only reversed by an immediate pericardiocentesis followed by surgical haemostasis. The second patient, although stable, had a large echographic pericardial effusion. Emergent sternotomy revealed a large amount of blood in the pericardial space and two cardiac wounds with one on a coronary artery. Penetrating wounds in proximity to the heart, even in a stable patient, require aggressive attempts at ruling out a cardiac injury. Immediate echocardiography should be systematically performed to screen for pericardial fluid.
对于任何胸部穿透伤患者，即使生命体征无变化，也必须排除穿透性心脏损伤。应立即进行超声心动图检查以筛查心包积液。首例病例强调了漏诊时发生心脏压塞的风险。由于当时没有超声心动图医生在场，且高度怀疑颈部血管损伤，因此未进行超声心动图检查。急性心脏压塞导致的突然病情恶化，仅通过立即心包穿刺术随后进行手术止血才得以逆转。第二位患者虽然病情稳定，但超声心动图显示心包有大量积液。紧急开胸手术发现心包腔内有大量血液以及两处心脏伤口，其中一处位于冠状动脉。即使患者病情稳定，靠近心脏的穿透伤也需要积极排除心脏损伤。应系统地立即进行超声心动图检查以筛查心包积液。
