闭合性心脏创伤75例临床诊治分析  

Clinical diagnosis and treatment of 75 cases of nonpenetrating cardiac trauma

作　　者：徐飞[1] 杨凡[2] 廖永晖[3] 贾伟[4] 杨磊[4] 千年松[5] 赵宏[5] 

机构地区：[1]中国人民解放军第302医院肿瘤放射治疗中心,北京100039 [2]第四军医大学西京医院,陕西西安710032 [3]第四军医大学人体解剖教研室,陕西西安710032 [4]中国人民解放军总医院海南分院肝胆外科,海南三亚571000 [5]中国人民解放军总医院海南分院肿瘤内科,海南三亚571000

出　　处：《海南医学》2014年第8期1114-1117,共4页Hainan Medical Journal

基　　金：北京市科技新星资助计划(编号:xx2013107);解放军总医院临床科研扶持基金(编号:2012FC-CXYY-4008);三亚市医疗卫生科技创新项目(编号:YW1304)

摘　　要：目的探讨闭合性心脏创伤的早期诊断和治疗方法。方法将75例心脏创伤区患者用院前评分中的创伤指数(TI)量化伤情分为轻中度伤(36例)、重度伤(23例)、危重伤组(16例)。胸片、心电图、彩超、血清学检查均在伤后24 h内进行,重点观察患者24 h内、1 d、3 d、5 d的心肌肌钙蛋白I(cTnI)、心肌肌钙蛋白T(cTnT)、血清心肌酶(CK-MB)的动态变化,严密监护及控制心律失常,视病情选择治疗方案。结果本组病例痊愈70例,死亡5例。ECG与血清cTnI、cTnT和CK-MB含量的变化比较,ECG在预测心肌损伤时具有很高的灵敏性,cTnI、cTnT异常时则对心肌损伤具有很高特异性。结论心脏闭合性创伤易误诊、漏诊,cTnI、cTnT、CK-MB和心电图结合影像检查可以大大提高早期诊断准确率。Objective To investigate the early diagnosis and treatment of nonpenetrating cardiac trauma. Methods Seventy-five patients with cardiac trauma quantified by the score in pre-hospital trauma index （TI） were divid- ed into three groups： mild to moderate injury group （n=36）, severe injury group （n=23）, and critical injury group （n=16）. X-ray chest film, electrocardiogram, ultrasound, serum examination were checked within 24 hours alter injury.. The dynam- ic changes of cardiac troponin I （eTnI）, cardiac tmponin T （cTnT）, cardiac enzymes （CK-MB） within 24 h, 1 d, 3 d, 5 d were observed. Intensive care, control of arrhythmia, and appropriate treatment were performed. Results Seventy patients were cured and 5 died. ECG was found more sensitive than cTnI, cTnT, CK-MB in the evaluation of cardiac trauma, while eTnI, eTnT were more specific when they were abnormal. Conclusion Nonpenetrating cardiac trauma is often misdi- agnosed or ignored. The combined detection of eTnI, eTnT, CK-MB and ECG, as well as imaging can greatly improve the accuracy of early diagnosis.

关 键 词：心脏创伤 心肌损伤 非穿透性 

分 类 号：R641[医药卫生—外科学]