穿透性心脏创伤21例院内救治分析

The treating report of 21 cases with penetrating heart trauma

目的 总结穿透性心脏创伤的诊断和治疗经验。方法 回顾性分析作者 11年来收治的 2 1例穿透性心脏创伤后急救处理的临床资料。结果 本组 2 1例均施行急诊手术 ,1例心肌修补后因心包窗口小术后并发心脏压塞 ,经穿刺置管引流不畅于术后 9d再次开胸行扩大切除心包窗口引流治愈。另 1例在术后11d出现精神症状。全组均能恢复正常生活和工作 ,无病残和死亡。结论 对开放性胸外伤伴有动脉收缩压降低、脉压变小、中心静脉压升高的Beck“三联症”和B超检查提示心包腔积液可确诊。

Objective To discuss the diagnosis and treatment of penetrating heart trauma.Methods We retrospectively analized the clinical data of 21 patients with penetrating heart trauma in the latest 11 years.Results All the 21 patients were performed the urgent operation.One patient had cardiac tamponade after the operation of mending myocardium because the pericardium window was too small,and it was not effective to puncture to put a tube for drainage.After nine days of the operation the patient was operated again to resect more pericaidium to drain,and was cured.Another patient had psychiatric symptom after eleven days of the operation.Conclusion The patients with open chest trauma can be diagnosed penetrating heart trauma if he has Beck Triad Sings with systolic pressure decreasing,pulse pressure reducing and central venous pressure increasing,and has echocardiography.The urgent operation of opening chest is the only one effective treatment to reduce the mortality.