扩创探查在亚临床型心脏穿透伤诊治中的意义  

The significance of chest wall injury exploration in diagnosis and treatment of sub-clinical penetrating cardiac trauma

作　　者：王波[1] 许果[1] 王继相[1] 佘恺[1] 熊伟[1] 曾涛[1] 白上林[1] 

机构地区：[1]四川省绵阳404医院川北医学院第二附属医院心胸血管外科绵阳心血管疾病研究所,四川绵阳621000

出　　处：《海南医学》2008年第1期10-12,共3页Hainan Medical Journal

摘　　要：目的探讨扩创探查在亚临床型心脏穿透伤诊治中的意义。方法回顾分析本院16年间救治的36例入院时表现为亚临床型心脏穿透伤病人的临床资料,按年代的先后将其分为两组,组1(1990年1月～1999年12月,共14例)和组2(2000年1月～2006年12月,共22例)。组1患者在明确诊断或出现临床型心脏穿透伤表现后开胸手术,组2患者急诊扩创探查后开胸手术。结果组1的院前时间(T1)、急诊室至开胸手术的时间(T2)、麻醉时修订创伤计分(RTS2)分别为1.65±0.42小时,4.1±0.86小时和4.34±1.02;组2的T1、T2、RTS2分别为0.91±0.37小时(P﹤0.05),0.86±0.33小时(P﹤0.01)和7.88±0.81(P﹤0.01)。两组的入院时修订创伤计分(RTS1)、损伤严重度评分(ISS)差别无显著性意义(P>0.05)。全组死亡4例,总死亡率11.11%。组1死亡3例,死亡率21.42%;组2死亡1例,死亡率4.55%(P﹤0.01)。结论扩创探查可尽快、准确诊断心脏穿透伤,并及时开胸手术抢救,提高了抢救成功率。Objective To identify the significance of exploration of chest wall injury in diagnosis and treatment of sub-clinical penetrating cardiac trauma. Methods Thirty-six patients of sub-clinical PCT accepted from January 1990 to December 2006 were reviewed retrospectively. They were divided into 2 groups （group 1： in the period from Jan.1990 - Dec.1999, 14 patients; group 2： in the period from Jan. 2001- Dec. 2006, 22 patients）. The patients in group 1 undergone thora- cotomy after final diagnosis or the emergence of clinical manifestation of clinical PCT. The patients in group 2 undergone thoracotomy after exploration of chest wall injury. Results In group 1 , the pre-hospital time （T 1） 、admission to thoracotomy time （T 2） and the Revised Trauma Score （RTS） at the time of anesthesia （RTS 2） was 1.65±0.42 h, 4.1±0.86 h and 4.34±1.02 respectively. The T 1 、T 2 and RTS 2 was 0.91±0.37 h （P﹤0.05）, 0.86±0.33 h （P﹤0.01）and 7.88±0.81（P﹤0.01） respectively in group 2. The difference of Revised Trauma Score（RTS） on admission （RTS 1） and injury severity score（ISS） between two groups had no statistical significance（P〉0.05）. A total death was 4 cases with overall mortality of 11.11%. The mortality was signifycantly decreased in group 2 （4.55%） as compared with group 1 （21.42%, P﹤0.01）. Conclusions Chest wall injury exploration could promptly make a final diagnosis of PCT. The thoracotomy taken as early as possible could increase the achievement ratio of emergency treatment of PCT.

关 键 词：心脏穿透伤 扩创探查 开胸手术 

分 类 号：R654.2[医药卫生—外科学]