心脏穿透伤224例的临床分型和处理  

Clinical type and management of 224 patients with penetrating cardiac trauma

作　　者：梁贵友[1] 石应康[1] 杨建[1] 张尔永[1] 

机构地区：[1]四川大学华西医院胸心血管外科,成都610041

出　　处：《中国胸心血管外科临床杂志》2003年第1期22-25,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：卫生部科研基金资助项目 (98-1-2 2 7)

摘　　要：目的　为了比较不同时期心脏穿透伤 (PCT)的流行病学、诊治疗效的发展趋势 ,探讨临床分型对 PCT救治的指导意义以及影响预后的因素。　方法　对 15家三级医院 1990年 1月～ 2 0 0 1年 10月收治的 PCT共 2 2 4例进行回顾性研究 ,按年代的先后将其分为两组 ,组 1(1990年 1月～ 1995年 12月 ,92例 )和组 2 (1996年 1月～ 2 0 0 1年 10月 ,132例 ) ;并根据入院时的临床表现分为亚临床型、临床型 ,后者又分为心脏压塞型和失血休克型。　结果　亚临床型 5 3例 ,其院前时间 (T1)、入院时修订创伤计分 1(RTS1)分别为 0 .74± 0 .5 4小时和 5 .35± 0 .87;临床型171例 ,T1、RTS1分别为 1.5 0± 2 .6 0小时和 4 .2 9± 1.6 4 (P<0 .0 5 ) ,两型的麻醉时修订创伤计分 (RTS2 )、损伤严重度评分 (ISS)差别无显著性意义 (P>0 .0 5 )。全组死亡 36例 ,总死亡率 16 .0 7%。其中亚临床型死亡 2例 ,心脏压塞型 9例 ,失血休克型 2 5例。组 1死亡 2 0例 ,死亡率为 2 1.74 % ;组 2死亡 16例 ,死亡率下降至 12 .12 % (P<0 .0 1)。　结论　 PCT的发生率呈逐年增高趋势 ,要提高 PCT的抢救成功率 ,应加强院前救治和转运 ,简化诊断方法 ,尽早开胸手术治疗。临床分型对救治具有指导意义。Objective To compare the epidemiological development trends, diagnosis and management of penetrating cardiac trauma (PCT) in different periods , to identify the significance of clinical types of PCT, and to determine the predictor of outcome. Methods Two hundred and twenty four patients of PCT treated in 15 Level Ⅲ hospitals from Jan.1990 to Oct.2001 were reviewed retrospectively. They were divided into 2 groups (group 1: in the period from Jan.1990-Dec. 1995, 92 patients, group 2: in the period from Jan. 1996-Oct.2001, 132 patients) and 3 types (sub clinical, cardiac tamponade, hemorrhagic shock,the latter two named clinical type) according to the period and clinical manifestation respectively. All the patients were undergone thoracotomy within 24h after injury. Results Fifty three patients of sub clinical type that their pre hospital time(T 1) was 0.74±0.54 h, the Revised Trauma Score (RTS) on admission (RTS 1) was 5.35±0.87, and 171 cases of clinical type with T 1, RTS 1 of 1.50± 2.60 h,4.29±1.64 respectively ( P <0.05). The difference of RTS 2 (RTS at the time of anesthesia) and injury severity score (ISS) between sub clinical and clinical type had no statistical significance ( P >0 05). A total death was 36 cases with overall mortality of 16.07%. Among these 36 patients, there were 25 of hemorrhagic shock, 9 of cardiac tamponade, 2 of sub clinical ( P <0.01). The mortality was significantly decreased in group 2 (12.12%) as compared with group 1 (21.74%, P <0.01). Conclusions Although morbidity of PCT in penetrating chest trauma continue to increase steadily, hospital mortality had been decreased in recent years. In order to improve the therapeutic effect of PCT, the pre hospital time should be as short as possible, the diagnostic program should be simplified and the thoracotomy should be taken as early as possible. Clinical type is a valuable guide for treatment.

关 键 词：心脏穿透伤 临床分型 外科手术 治疗 

分 类 号：R654.2[医药卫生—外科学]