亚临床型穿透性心脏损伤21例诊治分析

Study on diagnosis and treatment of 21 cases with the subclinical type of penetrating heart damage

目的总结亚临床型穿透性心脏损伤的诊治经验。方法回顾性分析我院近5年(2007年1月至2012年2月)收治的21例亚临床型心脏损伤病例,致伤原因均为刀刺伤,胸壁伤口位于左锁骨中线内3,4,5肋间16例,位于右锁骨中线内4,5肋间5例。全部病例均有心包裂伤,18例为心室的不全裂伤,2例为心房不全裂伤,均行了心脏裂伤修补术。还有1例为左冠状动脉前降支,回旋支断裂,行了左前降支,回旋支冠脉吻合术。结果全部病例均治愈出院,无创伤或手术相关并发症。结论伤口扩创探查是发现亚临床型穿透性心脏损伤的可靠诊断方法,若伤口已清创缝合,心包B超检查发现心包积液对诊断亚临床型心脏损伤有重要意义。及时剖胸探查是救治亚临床型穿透性心脏损伤的有效方法。

Objective To summarize the diagnosis and treatment of the subclinical type of penetrating heart damage. Methods Twenty - one cases with the subclinical type of heart damage caused by knife - stabbed wound from January., 2007 to Feburary, 2012 in the Affiliated Hosptial of Zunyi Medical Col- lege were anlyzed retrospectively. Sixteen cases of chest wall wounds were located in the left midclavicu- lar line among the third, fourth and fifth intercostal space and other 5 cases were in the right midclavicu- lar line between the fourth and fifth intercostal space. In 21 cases, 18 patients with incomplete ventricu- lar laceration and 2 patients with incomplete atrial laceration were treated with heart laceration repair and 1 patient with the fracture of left anterior descending coronary artery and circumflex received coronary ar- tery anastomosis. Results All cases were cured without trauma and operation related complications. Con- clusion The wound debridement exploration could be well used for the diagnosis of the subclinical type of penetrating heart damage. After the wound debridement and suture, pericardial B ultrasonic examination can detect the pericardial effusion and might play an important role in the diagnosis of subclinical type heart damage. Timely thoraeotomy exploration is effective in the treatment of the subclinical type of pen- etrating heart damage.