钝性心脏损伤348例分析  

Blunt cardiac injury:analysis of 348 patients

作　　者：高劲谋 孔令文 李辉[2] 都定元 刘朝普 李昌华 杨俊[2] 赵山红 Gao Jinmou;Kong Lingwen;Li Hui;Du Dingyuan;Liu Chaopu;Li Changhua;Yang Jun;Zhao Shanhong(Department of Cardiothoracic surgery,Central Affiliated Hospital of Chongqing University,Chongqing Emergency Medical Center,Chongqing 400014,China;Department of Traumatology,Central Affiliated Hospital of Chongqing University,Chongqing Emergency Medical Center,Chongqing 400014,China)

机构地区：[1]重庆大学附属中心医院,重庆市急救医疗中心胸心外科,400014 [2]重庆大学附属中心医院,重庆市急救医疗中心创伤科,400014

出　　处：《中华急诊医学杂志》2019年第11期1390-1394,共5页Chinese Journal of Emergency Medicine

摘　　要：目的探讨钝性心脏损伤(blunt cardiac injury,BCI)的早期诊断、治疗方法和效果。方法回顾分析2003年9月至2018年8月重庆市急救医疗中心收治BCI患者的病历资料,包括性别、年龄、伤因、诊断治疗方法和结局。患者分为手术组和非手术组,对两组临床资料作比较分析。结果348例BCI患者占同期钝性胸部损伤的18.3%。伤因中交通事故占48.3%。诊断项目主要为心电图、心肌酶谱和肌钙蛋白、超声心动图和螺旋CT;或在紧急剖胸术中证实。非手术组305例,主要为心肌挫伤等,病死率6.9%;手术组43例,主要为心脏破裂和心包疝等,病死率32.6%。非手术组和手术组心电图阴性分别占16.7%和11.6%,差异无统计学意义(P>0.05)。手术组休克发生率和病死率均明显高于非手术组(P<0.01);直接死于心脏伤例数差异有统计学意义(P<0.05)。本组BCI患者总病死率10.1%。结论钝性胸伤均应怀疑BCI而做相应检查和监测。不需手术的心肌挫伤应重视心肌保护、促进水肿吸收,采用药物控制较重的心律紊乱。需要手术者,及时诊断、迅速剖胸是获救关键。Objective To explore the early diagnosis,therapeutic methods and efficacy for blunt cardiac injury(BCI).Methods All BCI patients from September 2003 to August 2018 were studied retrospectively in respect of sex,age,cause of injury,diagnostic methods,therapeutic procedures,and outcome.The patients were divided into two groups:nonoperative group(n=305)and operative group(n=43).The two groups were compared and analyzed.Results Totally 348 BCI patients accounted for 18.3%of 1903 patients with blunt thoracic injury(BTI),and the mortality rate was 10.1%.The main cause of injury was traffic accident with an incidence of 48.3%.The diagnostic methods included electrocardiogram(ECG),enzymes and troponin I,echocardiography,and CT scanning,or confirmed by emergency thoracatomy.In the nonoperative group,patients were mainly myocardial contusion,with a mortality rate of 6.9%.In the operative group,patients were mainly cardiac rupture and pericardial hernia,and the mortality was 32.6%.The incidence of negative ECG between the two groups was not significantly different(16.7%vs 11.6%,P>0.05).The incidence of shock and mortality in the operative group were significantly higher than those in the the nonoperative group(P<0.01).The number of death directly resulted from BCI in the operative group was greater than that in the nonoperative group(P<0.05).Conclusions For BTI patients,BCI must be highly suspected,and necessary examinations should be given.To manage myocardial contusion without surgery,it is necessary to protect the heart,alleviate edema of myocardium,and control arrhythmia with drugs.To deal with those patients requiring operation,early recognition and expeditious thoracotomy are essential.

关 键 词：创伤和损伤 钝性心脏损伤 心肌挫伤 心脏破裂 紧急剖胸术 

分 类 号：R54[医药卫生—心血管疾病]