心脏大血管创伤38例诊治分析

Analysis of Diagnosis and Treatment of the cardiovascular trauma in 38 cases

目的:总结心脏大血管创伤的诊断和治疗经验。方法:对心脏大血管创伤38例病例主要根据病史、临床症状、体征进行早期诊断,部分病例结合X线、超声心动图及心包穿刺结果确诊。全组病例中,穿透伤23例,部分心肌裂伤7例,心脏闭合性损伤8例,其中单纯心肌挫伤5例,心肌挫伤伴主动脉、室间隔、三尖瓣损伤各1例。除5例单纯心肌挫伤病人行保守治疗外,其余均经手术治疗。结果:38例中治愈33例,治愈率86.84%;死亡5例,死亡率13.16%。结论:心脏大血管创伤的早期诊断和紧急处理是提高生存率的关键,对于心脏闭合性损伤,除非有难以控制的心力衰竭,手术应在伤后2月进行为宜。

Objective:To summarize the experience of diagnosis and surgical treatment of cardiovascular trauma.Methods: The early diagnosis was made by way of the history and clinical symptoms,chest X-ray,echocardiogram and pericardiocentesis was needed in some patients.In these patients,penetrating wounds were found in 23 cases,partial myocardial laceration were found in 7 cases,non-penetrating injuries in 8 cases,which consisted of myocardial contusion in 5 cases,myocardial contusion plus aortic valve injury in 1 case,myocardial contusion plus ventricular sepal injury in 1 case,myocardial contusion plus tricuspid valve injury in 1 case.5 patients with myocardial contusion were treated conservatively, others with cardiovascular trauma were all treated surgically.Results:in this series 33 cases were cured (86.84%),five cases were dead(13.16%).Conclusion:Early diagnosis and fast treatment are the key to manage cardiovascular trauma,To blunt heart trauma,unless accompanying a uncontrolled progressive heart failure,the proper opportunity for operation may be within two months.