心脏闭合性损伤后晚期并发症和后遗症的诊断与治疗

Diagnosis and Treatment of Delayed Complications and Sequelae after Closed Cardiac Injury

目的：笔者报告心脏闭合性损伤晚期并发症和后遗症７例，旨在提高临床对这类病变的诊断和治疗水平。方法：本组病例根据外伤史、临床征象并结合胸部Ｘ线和心电图等检查提示了这类晚期病变。本组主要依靠二维超声心动图和彩色多普勒确立诊断。确诊时间为伤后４０～７３０天。结果：全组计有迟发性纤维素性血心包和缩窄性心包炎各１例，均进行了部分心包切除术；室壁瘤合并室间隔穿孔１例，作了室壁瘤切除及室间隔缺损修补术；二尖瓣关闭不全１例，施行了二尖瓣替换术；三尖瓣关闭不全３例，除１例返流小保守治疗外，余２例分别接受了三尖瓣修复术和换瓣术。全组均康复出院。结论：对心脏闭合性损伤都应作长期随访观察；二维超声心动图和彩色多普勒是检出这类病变简单而可靠的手段；这类病变的手术时机、手术方式和方法应根据伤情和病变来决定。

Aim: To improve the clinical diagnosis and treatment of delayed complications and sequelae after closed cardiac injury. Methods: Seven cases were reported. There were 5 males and 2 females, the age ranged from 13 to 37 years. The diagnostic track of this disease was obtained according to the history of trauma, clinical signs, chest X ray and electrocardiogram, etc. The definite diagnosis could be comfirmed by colour Doppler and two dimensional echocardiography (2DE). The median duration between injury and diagnosis was 242 days (ranging from 40 to 730 days). Results: Partial pericardiectomy was performed for the delayed fibrinous hemopericardium (1 case) and constrictive pericarditis (1 case) respectively. Resection of ventricular aneurysm (VA) and repair of ventricular septal defect were performed in 1 patient with left VA and perforation of ventricular septum. Mitral valve replacement was performed in one patient with mitral insufficiency. There were 3 patients with traumatic tricuspid insufficiency, of whom one was treated conservatively because of small regurgitation, two were treated surgically (tricuspid valve repair in 1 patient and replacement in another). No deaths occurred and all were recovered. Conclusion: It's pointed out that (1) Long term follow up is indicated for closed cardiac injury.(2)Colour Doppler and 2DE are simple and reliable diagnostic methods for such cases. Surgical indication, operative method and approaches for such cases should be determined by conditions of patients and findings during operation.