Chirillo F, Totis O, Cavarzerani A, Bruni A, Farnia A, Sarpellon M, Ius P, Valfrè C, Stritoni P
Department of Cardiology, Regional Hospital, Treviso, Italy.
Heart. 1996 Mar;75(3):301-6. doi: 10.1136/hrt.75.3.301.
To assess the diagnostic potential of transthoracic and transoesophageal echocardiography for the detection of traumatic cardiovascular injuries in patients suffering from severe blunt chest trauma.
Prospective study over a three year period.
A regional cardiothoracic centre.
134 consecutive patients (94 M/40 F; mean age 38 (SD 14) years) suffering from severe blunt chest trauma (injury severity score 33.5 (18.2)). Most patients (89%) were victims of motor vehicle accidents.
All patients underwent transthoracic and transoesophageal echocardiography within 8 h of admission. Aortography was performed in the first 20 patients and in a further five equivocal cases.
Transthoracic echocardiography provided suboptimal images in 83 patients, detecting three aortic ruptures, 28 pericardial effusions (one cardiac tamponade), 35 left pleural effusions, and 15 myocardial contusions. Transoesophageal echocardiography was feasible in 131 patients and detected 14 aortic ruptures (13 at the isthmus), 40 pericardial effusions, 51 left pleural effusions, 34 periaortic haematomas, 45 myocardial contusions, right atrial laceration in one patient with cardiac tamponade, one tricuspid valve rupture, and one severe mitral regurgitation caused by annular disruption. For the detection of aortic rupture transoesophageal echocardiography showed 93% sensitivity, 98% specificity, and 98% accuracy. Time to surgery was significantly shorter (30 (12) v 71 (21) min; P < 0.05) for patients operated on only on the basis of transoesophageal echocardiographic findings.
Transthoracic echocardiography has low diagnostic yield in severe blunt chest trauma, while transoesophageal echocardiography provides accurate diagnosis in a short time at the bedside, is inexpensive, minimally invasive, and does not interfere with other diagnostic or therapeutic procedures.
评估经胸超声心动图和经食管超声心动图对严重钝性胸部创伤患者创伤性心血管损伤的诊断潜力。
为期三年的前瞻性研究。
一个地区心胸中心。
134例连续的严重钝性胸部创伤患者（94例男性/40例女性；平均年龄38（标准差14）岁）（损伤严重程度评分33.5（18.2））。大多数患者（89%）为机动车事故受害者。
所有患者在入院后8小时内接受经胸和经食管超声心动图检查。前20例患者及另外5例诊断不明确的病例进行了主动脉造影。
83例患者经胸超声心动图成像欠佳，检测到3例主动脉破裂、28例心包积液（1例心脏压塞）、35例左侧胸腔积液和15例心肌挫伤。131例患者可行经食管超声心动图检查，检测到14例主动脉破裂（13例在峡部）、40例心包积液、51例左侧胸腔积液、34例主动脉周围血肿、45例心肌挫伤、1例心脏压塞患者右心房撕裂、1例三尖瓣破裂以及1例因瓣环破裂导致的严重二尖瓣反流。对于主动脉破裂的检测，经食管超声心动图的敏感性为93%，特异性为98%，准确性为98%。仅根据经食管超声心动图检查结果进行手术的患者，手术时间明显更短（30（12）分钟对71（21）分钟；P<0.05）。
经胸超声心动图在严重钝性胸部创伤中的诊断率较低，而经食管超声心动图可在床边短时间内提供准确诊断，价格低廉，微创，且不干扰其他诊断或治疗程序。
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