Carrillo E H, Heniford B T, Dykes J R, McKenzie E D, Polk H C, Richardson J D
Department of Surgery, University of Louisville School of Medicine, Kentucky 40292, USA.
J Trauma. 1997 Jul;43(1):19-23. doi: 10.1097/00005373-199707000-00007.
Rupture of the pleuropericardium (PP) occurs rarely, with most patients dying of associated injuries before arriving at the hospital. Among patients who initially survive, the diagnosis is often delayed until cardiogenic shock secondary to cardiac herniation is evident.
The records of 10 patients with PP lacerations and cardiac herniations were reviewed.
All but one patient had a normal chest x-ray (CXR) film on admission. After the patients became symptomatic, seven of nine had abnormal findings on CXR film demonstrating herniation of the heart into the left hemithorax. The other two patients underwent surgery without a repeat CXR film. Except for one who was taken directly to the operating room, all patients had been previously stabilized before developing cardiogenic shock, on average 9 hours after admission. Operative therapy was closure of the pericardium for five patients and completion pericardiotomy for the others. All survivors developed significant complications, and four of them died.
The diagnosis of PP rupture should be considered for patients with multiple trauma who develop sudden and unexpected cardiogenic shock after their initial condition has been stabilized. A repeat CXR film is diagnostic in most cases and should be used as the most efficient and expeditious route to making the diagnosis.
胸膜心包破裂（PP）很少发生，大多数患者在抵达医院前死于相关损伤。在最初存活的患者中，诊断往往延迟到心脏疝导致的心源性休克明显时才做出。
回顾了10例PP撕裂和心脏疝患者的病历。
除1例患者外，所有患者入院时胸部X线（CXR）片均正常。患者出现症状后，9例中有7例CXR片有异常表现，显示心脏疝入左半胸。另外2例患者未复查CXR片即接受了手术。除1例直接被送往手术室的患者外，所有患者在发生心源性休克前病情均已稳定，平均入院后9小时。手术治疗为5例患者缝合心包，其余患者行心包切开术。所有幸存者均出现严重并发症，其中4例死亡。
对于多发伤患者，在初始病情稳定后出现突发且意外的心源性休克，应考虑PP破裂的诊断。在大多数情况下，复查CXR片具有诊断价值，应作为最有效、最快捷的诊断途径。
