Wall M J, Mattox K L, Chen C D, Baldwin J C
Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
J Trauma. 1997 May;42(5):905-12. doi: 10.1097/00005373-199705000-00022.
Injury to the heart has been studied extensively. However, a small group of patients with injuries to the coronary arteries or intracardiac structures may require a different operative approach.
Retrospective review of a cardiovascular injury database.
Over a 20-year period, 711 cardiac injuries were treated. The mean age of the victims was 31.1 (90% men). Causes were primarily stab wounds (54%) and gunshot wounds (42%). Cardiac chambers injured included the right ventricle (40%), left ventricle (40%), right atrium (24%), and left atrium (3%). The overall mortality was 47%. Sixty complex injuries occurred. Of 21 left anterior descending coronary artery injuries (76.2% mortality), two patients presented with sufficient signs of life to warrant emergent coronary artery bypass (mortality 50%). There were seven circumflex/obtuse marginal coronary artery injuries, all treated with ligation (mortality 71.4%). Eight right/posterior descending coronary artery injuries (mortality 62.5%) were seen, and all but one were treated with ligation. The one patient not treated with ligation underwent coronary bypass and died. Delayed mitral valve replacement was performed for two valvular injuries (mitral). There were a total of 14 intracardiac fistulas (mortality 35.7%). All six of the surviving patients with ventricular septal defect required reoperation.
The mortality for complex injuries (coronary, septal, valvular) was 53%. This group was a specific population that self-selected by surviving to operation. Acute operations for complex injuries (beyond cardiorrhaphy) were primarily heroic life-saving efforts. Reoperation for cardiac injuries was most common for septal or valvular injuries. Only 2% of all survivors required reoperation to correct a residual defect.
心脏损伤已得到广泛研究。然而，一小部分冠状动脉或心内结构损伤的患者可能需要不同的手术方法。
对心血管损伤数据库进行回顾性研究。
在20年期间，共治疗了711例心脏损伤患者。受害者的平均年龄为31.1岁（90%为男性）。致伤原因主要是刺伤（54%）和枪伤（42%）。受伤的心腔包括右心室（40%）、左心室（40%）、右心房（24%）和左心房（3%）。总体死亡率为47%。发生了60例复杂损伤。在21例左前降支冠状动脉损伤中（死亡率76.2%），有2例患者有足够的生命体征，需要紧急进行冠状动脉搭桥手术（死亡率50%）。有7例旋支/钝缘支冠状动脉损伤，均采用结扎治疗（死亡率71.4%）。观察到8例右/后降支冠状动脉损伤（死亡率62.5%），除1例患者外均采用结扎治疗。未接受结扎治疗的1例患者接受了冠状动脉搭桥手术，但死亡。对2例瓣膜损伤（二尖瓣）进行了延迟二尖瓣置换术。共有14例心内瘘（死亡率35.7%）。所有6例存活的室间隔缺损患者均需要再次手术。
复杂损伤（冠状动脉、间隔、瓣膜）的死亡率为53%。这组患者是通过手术存活下来的特定人群。针对复杂损伤（超出心脏修补术）的急诊手术主要是英勇的挽救生命的努力。心脏损伤再次手术最常见于间隔或瓣膜损伤。所有幸存者中只有2%需要再次手术以纠正残余缺陷。
