Bruch C, Baumgart D, Görge G, Pink R, Schaar J, Schönfelder B, Markgraf G, Olivier L, Drochner D, Kabatnik M, Erbel R
Abteilung Kardiologie, Universität Gesamthochschule Essen.
Dtsch Med Wochenschr. 1998 Feb 27;123(9):244-9. doi: 10.1055/s-2007-1023944.
A 37-year-old woman who was not wearing a seat-belt while driving a car had a head-on collision at 70 km/h. On arrival of the emergency physician she was awake and responsive but complained of pain with bruising over the sternum and the epigastrium. Pressure on the sternum was painful. Arterial pressure was 95/60 mm Hg, heart rate 112/min. On admission the heart sounds were unremarkable and peripheral pulses normal. Vesicular sounds were heard over both lungs. In addition to multiple facial abrasions voluntary movements were impaired and the right knee-joint was swollen.
The ECG showed sinus tachycardia (103 beats/min) with left axis deviation, but was otherwise unremarkable. Initially the haemoglobin was 12.6 g/dl with normal white cell and platelet counts. Clotting tests, serum transaminases, creatine kinase, lactate dehydrogenase and other routine laboratory tests were within normal limits.
Because the haemoglobin level had fallen to 7.7 g/dl within the first 4 hours erythrocytes concentrate was infused. The chest radiogram and subsequent computed tomography showed a mediastinal and paraaortic haematoma of unclear origin. Transoesophageal echocardiography (TEE) demonstrated rupture of the descending aorta with free floating intraluminal parts of the intima in the isthmal region, just distal to the origin of the left subclavian artery, which was not occluded. Colour Doppler echocardiography revealed abnormal flow into mediastinal and paraaortic tissues. At operation the echocardiographic findings were confirmed and part of the descending aorta was replaced by a 3 cm dacron tube during an aortic crossclamping time of 37 min. The patient was discharged after a postoperative stay of average length, during which her other injuries were treated.
After blunt thoracic or deceleration trauma earliest possible TEE is indicated, because it can at once provide details of extent and degree of injury to heart and/or aorta.
一名37岁女性在驾车时未系安全带，遭遇了时速70公里的正面碰撞事故。急救医生赶到时，她神志清醒，反应灵敏，但主诉胸骨和上腹部疼痛且有瘀伤。按压胸骨时疼痛。动脉血压为95/60毫米汞柱，心率112次/分钟。入院时心音无异常，外周脉搏正常。双肺可闻及肺泡呼吸音。除多处面部擦伤外，自主运动受损，右膝关节肿胀。
心电图显示窦性心动过速（103次/分钟）伴电轴左偏，其他方面无异常。最初血红蛋白为12.6克/分升，白细胞和血小板计数正常。凝血试验、血清转氨酶、肌酸激酶、乳酸脱氢酶及其他常规实验室检查均在正常范围内。
由于血红蛋白水平在最初4小时内降至7.7克/分升，遂输注红细胞浓缩液。胸部X线片及随后的计算机断层扫描显示纵隔及主动脉旁血肿，来源不明。经食管超声心动图（TEE）显示降主动脉破裂，在左锁骨下动脉起始部远端的峡部区域，内膜腔内部分游离漂浮，左锁骨下动脉未闭塞。彩色多普勒超声心动图显示有异常血流进入纵隔及主动脉旁组织。手术中证实了超声心动图检查结果，在主动脉阻断37分钟期间，用一根3厘米的涤纶血管替换了部分降主动脉。患者术后住院时间为平均时长，期间其他损伤得到治疗，之后出院。
钝性胸部创伤或减速伤后，应尽早进行TEE检查，因为它能立即提供心脏和/或主动脉损伤的范围和程度的详细信息。
