非典型心脏穿透伤:两种极端情况的处理特点分析

王俊峰，付玉东，阚强波等.非典型心脏穿透伤:两种极端情况的处理特点分析[J].中华创伤杂志.2013, 29(3)221-223.

心脏穿透伤,小切口心包探查术,急诊室剖胸术.

王俊峰，付玉东，阚强波，侯波，王萍仙，杨建

655000,曲靖市第一人民医院胸心外科;四川大学华西医院胸心血管外科

2013

221-223

2,万方

目的 探讨心脏穿透伤(penetrating cardiac trauma,PCT)的亚临床型、濒死型两种极端情况的处理要点. 方法 回顾性分析2005年1月-2012年3月收治的135例PCT患者的临床资料,分为亚临床型、临床型(心脏压塞型或失血性休克型)和濒死型；对亚临床型、濒死型两种极端情况的处理分组讨论. 结果 (1)亚临床型30例脱离观察而未及时诊断救治死亡22例,11例经留院密切观察或经心脏探查而及时确诊并送手术室剖胸术(operating room thoracotomy,ORT),死亡3例；濒死型27例送ORT,死亡15例,急诊室剖胸术(emergency room thoracotomy,ERT)死亡2例；临床型67例送ORT,死亡7例.(2)各型患者及时确诊或经留院观察-心脏探查而确诊,并经ORT或ERT抢救共生存86例,术后随访3～ 24个月,均恢复良好. 结论 PCT的亚临床型患者给予密切观察及时行心脏探查确诊,濒死型患者及时行ERT复苏和控制出血,能提高PCT的救治率. ： Objective To investigate the key points for management of subclinical and agonal types of penetrating cardiac trauma (PCT).Methods A retrospective analysis was conducted on clinical data of 135 PCT cases treated from January 2005 to March 2012.The cases were divided into subclinical type,clinical type (cardiac tamponade or hemorrhagic shock types) and agonal type.Managements of the two extreme types including subclinical type and agonal type were studied in groups.Results (1) Thirty cases of subclinical type failed to have timely diagnosis and treatment due to the withdrawal from inhospital observation,which resulted in 22 deaths.Eleven cases of subclinical type had timely diagnosis through in-hospital observation or cardiac exploration,but three cases died in operating room thoracotomy (ORT).There were 27 cases of agonal type,but 15 died in ORT and two died in emergency room thoracotomy (ERT).Of 67 cases of clinical type,seven died in ORT.(2) A total of 86 cases survived ORT or ERT after timely diagnosis or diagnosis through in-hospital observation plus cardiac exploration.In the meantime,sound recovery was observed in 3-24 months of follow-up.Conclusion Success rate in treatment of PCT can be enhanced by close observation and timely cardiac exploration for subclinical type PCT and by timely ERT and bleeding control for agonal type PCT.