76例心脏及胸部大血管穿透伤的手术时机及救治策略

Operation time and treatment strategy for 76 cases with penetrating injuries in heart and thoracic great vessels

目的总结心脏及胸部大血管穿透性损伤的救治经验。方法收集76例心脏及胸部大血管穿透性损伤患者的临床资料,总结其临床特点及救治经验。结果 73例急诊下开胸止血,3例锁骨下动脉损伤在造影室行支架植入术后再入手术室行颈根部血肿清除术。死亡9例,其余伤者全部痊愈出院。心脏压塞型及亚临床型伤者无1例死亡。结论迅速明确伤情,果断剖胸探查是心脏大血管穿透伤抢救成功率的关键。对于部分指证适宜的伤者,大血管腔内治疗不失为一种值得推荐的手术方式。

Objective To summarize the therapeutic experience of patients with penetrating injuries in heart and thoracic great vessels. Methods Records of 76 victims with penetrating injuries in heart and thoracic great vessels from January 2000 to December 2012 were retrospectively reviewed. The data including the clinical types, pathological anatomy, treatments, and outcome were analyzed. Results Of the patients ,73 cases were treated with emergency operation and 3 cases with subclavian artery injured were treated with selective operation after endovaseular isolation using stent-graft placement. There were nine deaths. The mortality rate was 12%. Rest of patients were recovered and discharged from hospital. The patients with pericardial tamponade had higher survival rate. Conclusion It is very important to determine the traumatic conditions rapidly and correctly, and timely thoracic exploration is the key to improve the survival rate. Intravascualr treatment is a safe and effective therapeutic method with minimal invasion for partial with traumatic arterial injuries.