左心室穿透伤的诊断和治疗  

Diagnosis and treatment of penetrating injury to the left ventricle

作　　者：吴兆红[1] 谢伟国[1] 王戈菲[1] 陈岗东[1] 关国森[1] 高锦平[1] 

机构地区：[1]广州医学院附属市二人民医院心胸外科,广东广州510150

出　　处：《第一军医大学学报》2005年第4期479-480,共2页Journal of First Military Medical University

摘　　要：目的回顾总结连续6例左心室穿透伤的诊断和抢救治疗经验.方法连续6例胸部锐器外伤患者,男5例、女1例,伤后0.5～3 h送入我院急诊科,6例均有不同程度休克,3例有明显的心包压塞,均行左心室裂口修补,胸腔内自血回输和心包低位开窗引流.结果6例均被治愈,1例因胸腔内广泛渗血而二次开胸,2例术后心电图提示ST段改变,1例留有非特异性心室内传导迟延,T波倒置.结论提高心脏损伤诊断和抢救治疗成功率的关键,是对心脏损伤的警惕和认识.左心室穿透伤病情凶险,主要表现为低血压和心包压塞征象,建立建全急诊科、手术室、重症监护室的快捷通道是抢救成功的基础,急诊开胸止血、解除心包压塞是成功的关键.Objective To review our experiences with diagnosis and treatment of 6 cases of penetrating injury to the left ventricle. Methods Six patients were admitted to the emergency department 0.5 to 3 h after the injury, all with shock and 3 with obvious pericardiac tamponade. All the patients received immediate thoracotomy for repairing the ruptured left ventricle, subpericardial window and pericardiocentesis, with also blood autotransfusion. Results All patients survived the operations. One patient required reexploration because of hemorrahge in the chest and two presented ST-segment changes in postoperative ECG, and one had nonspecific intraventricular conduction delay with T-wave inversion. Conclusions Penetrating injury to the left ventricle is manifested by low blood pressure and signs of pericardial tamponade. Immediate thoracotomy to relieve the tamponade and effective hemostasis can be critical for management of such patients.

关 键 词：创伤 贯通性 心脏 左心室 

分 类 号：R654.2[医药卫生—外科学]