交通事故致心肌挫伤22例诊治及社区跟踪分析

Diagnosis,treatment and community follow-up of 22 cases of myocardial contusion caused by traffic accident

目的分析交通事故致心肌挫伤患者的诊治和随访情况,总结此类病例的诊治经验。方法对2012年6月~2014年6月本社区医院收治的22例交通事故致心肌挫伤患者诊断、治疗情况进行回顾性分析,并在患者出院后进行6个月的跟踪随访。结果 22例患者心肌挫伤确诊时间为入院后6h^4d,平均(2.8±1.2)d,入院时至伤后24、48、72、96hCK-MB升高构成比例分别为50.00%、81.82%、100.00%、100.00%、100.00%;cTnT阳性构成比例分别为31.82%、54.55%、72.73%、72.73%、77.27%。确诊后及时给予对症治疗,包括卧床、营养心肌、吸氧、止痛、抗感染等治疗后,CK和CK-MB于8~12d恢复正常,21例患者治愈出院,1例并发呼吸窘迫综合征患者转入上一级医院治疗。21例患者住院9~15d,平均(12.6±3.4)d,随访6个月,所有症状消失。结论心肌挫伤发病隐匿,症状表现不明显,在收治交通事故胸部钝性伤时应警惕心肌挫伤,及时诊断对症治疗预后较好。

Objective To analyze the diagnosis,treatment and follow-up records of patients with myocar-dial contusion caused by traffic accidents,to summarize the experience of treating such disease. Methods A retrospective analysis of diagnosis and treatment records was done for 22 patients with myocardial contusion in-duced by traffic accidents cared at our community hospital between June 2012 and June 2014,and patients were followed up for 6 months after discharge from hospital. Results Twenty-two cases of patients were diag-nosed with myocardial contusion within 6 h-4 d after admission to hospital,the average time was（2.8±1.2）d, at time points from hospitalization to 24,48,72,96 h after injury,the proportion of patients with elevated CK-MB was 50.00%,81.82%,100.00%,100.00%,100.00%,respectively;the proportion of positive-cTnT were 31.82%,54.55%,72.73%,72.73%,77.27%.Timely symptomatic treatment after diagnosis,including rest in bed,myocardial nutrition,oxygen inhalation,analgesia,anti-infection treatment,CK and CK-MB re-covered to normal in 8-12 days,21 patients were cured,1 case complicated with respiratory distress syndrome was transferred to a higher level hospital for treatment.The hospital duration of 21 cases lasted for 9-15 days, the average time was （12.6±3.4）days,the 6-month follow-up showed all symptoms disappeared. Conclu-sion The onset of myocardial contusion is occult and without obvious symptoms,myocardial contusion should be cautioned while treatment of blunt chest injury caused by traffic accidents,the prognosis is good by timely diagnosis and symptomatic treatment.