心脏大血管创伤诊断技术的研究进展

心脏大血管创伤无论在战时或和平时期均不少见，近年来，各项诊断技术的不断发展，极大的提高了急诊诊断率，为抢救治疗赢得时间。本文就此类创伤目前主要诊断技术的研究进展作一综述。     

心脏大血管创伤诊断技术的研究进展

心脏大血管创伤无论在战时或和平时期均不少见,近年来,各项诊断技术的不断发展,极大的提高了急诊诊断率,为抢救治疗赢得时间.本文就此类创伤目前主要诊断技术的研究进展作一综述.     

胸部大血管损伤的诊治体会

我院收治胸部大血管损伤42例,急诊抢救无效死亡5例,经手术治疗37例。37例中有32例痊愈出院,死亡5例。胸部大血管损伤的抢救应简化诊断方法,迅速手术,不放弃任何可能的机会,才能提高抢救成功率。     

心脏大血管创伤后晚期后遗症的诊断与处理

目的 报告心脏大血管创伤后晚期后遗症的诊断和处理。方法 收集我科１９５４年６月～１９９９年７月收治的２５例心脏大血管损伤后遗症病例资料,其中穿透伤１０列、闭合伤９例、医源性损伤６例。通过回顾其临床资料及随访结果,研究其诊断、处理方法的特点及预后。结果 ２３例经手术治疗痊愈,１例假性动脉瘤手术时出血死亡,１例因动脉导管结扎后,控制假性动脉瘤感染时,瘤体突然破裂出血死亡。结论 早期诊断、早期或择期手术     

52例心脏大血管损伤救治

５２例心脏大血管损伤救治刘维永易定华蔡振杰杨景学梁继河蔡建辉万明明心脏伤约占胸部创伤的２％～４％，是战时、交通事故或灾难医学中导致死亡的主要原因［１］。１９６４年以来我院收治心脏大血管伤５２例，笔者重点介绍有关救治经验。临床资料本组男４５例，女７例；...     

心脏大血管损伤

心脏大血管损伤可分为穿透性或非穿透性损伤两类。不论是闭合性或开放性胸部损伤，都可以引起心脏大血管损伤，并可合并胸部、腹部或颈部脏器伤。心脏大血管损伤的伤情多较危重，常伴有出血性休克、心脏压塞、严重合并伤或多处伤，如不及时抢救处理，死亡率极高。一、心脏...     

胸部撞击时心脏的动力学响应及心脏损伤

目的 观察胸部受撞击过程中心脏的动力学响应及心脏损伤的病理学特点。方法 以不同撞击速度和压缩响应对１１只犬和３４只兔进行胸前部撞击,监测胸壁的运动过程,观察心脏损伤特点２,运用数学模型分析损伤机制。结果 粘性标准与损伤程度密切相关;受撞击后胸壁发生压缩和扩张双向运动;心脏损伤以心内膜出血为主,心脏破裂多发于心室侧壁,光镜观察可见挫伤区心肌纤维断裂;     

胸部创伤合并心脏损伤的围手术期护理体会

通过对8例心脏损伤患者的术前抢救和术后护理措施的回顾性分析,认为伤员往往在极短时间内死于心脏压塞或失血性休克,应及时诊断并启动心脏外伤抢救护理程序配合抢救,施行剖胸止血术后应密切监护,加强呼吸道管理,保持胸腔引流管通畅,控制补液,预防和及时处理心脏并发症,以提高心脏损伤救治成功率.     

心脏、大血管创伤的临床救治

目的 探讨心脏、大血管刨伤的早期诊断及治疗经验。方法 回顾急诊手术治疗29例心脏、大血管创伤的临床资料，分析穿透性损伤和钝性损伤的临床特点，以及早期诊断及治疗特点。结果 全组死亡3例，死亡率为10％(3／29)，其中闭合性损伤2例，穿透伤1例；其余无并发症，痊愈出院，随访6个月～10年，恢复良好。结论 心脏、大血管创伤应早期准确诊断；加强对急性心脏压塞和(或)休克的处理，紧急开胸手术是改善预后的关键。     

胸部钝性伤致心脏破裂的救治

目的 探讨胸部钝性伤导致心脏破裂的外科救治方法。方法 回顾性总结20例胸部钝性伤致心脏破裂的外科治疗经验。结果 本组存活16例,均痊愈出院,随访3个月,心脏功能正常;死亡4例,其中术中死亡2例,术后死亡2例。结论 胸部钝性伤引起心脏破裂病例并不少见,抢救成功的关键是争取手术时间。心脏破裂部位以右心为多见,手术进路以胸骨正中切口为佳。应强调术中控制出血的有效措施及可靠的心脏破裂修补方法。     

Tracheal rupture caused by blunt chest trauma: radiological and clinical features

The aim of this study was to assess radiomorphologic and clinical features of tracheal rupture due to blunt chest trauma. From 1992 until 1998 the radiomorphologic and clinical key findings of all consecutive tracheal ruptures were retrospectively analyzed. The study included ten patients (7 men and 3 women; mean age 35 years); all had pneumothoraces which were persistent despite suction drainage. Seven patients developed a pneumomediastinum as well as a subcutaneous emphysema on conventional chest X-rays. In five patients, one major hint leading to the diagnosis was a cervical emphysema, discovered on the lateral cervical spine view. Contrast-media-enhanced thoracic CT was obtained in all ten cases and showed additional injuries (atelectasis n = 5; lung contusion n = 4; lung laceration n = 2; hematothorax n = 2 and hematomediastinum n = 4). The definite diagnosis of tracheal rupture was made by bronchoscopy, which was obtained in all patients. Tracheal rupture due to blunt chest trauma occurs rarely. Key findings were all provided by conventional chest X-ray. Tracheal rupture is suspected in front of a pneumothorax, a pneumomediastinum, or a subcutaneous emphysema on lateral cervical spine and chest films. Routine thoracic CT could also demonstrate these findings but could not confirm the definite diagnosis of an tracheal rupture except in one case; in the other 9 cases this was done by bronchoscopy. Thus, bronchoscopy should be mandatory in all suspicious cases of tracheal rupture and remains the gold standard. Received: 22 February 1999; Revision received: 29 June 1999; Accepted: 1 July 1999     

不同致伤原因重症胸外伤的临床特点及救治

目的　探讨不同致伤原因所致的重症胸外伤临床特点及其救治。方法　对 2 37例重症胸外伤(AIS≥ 3)病人的致伤原因、胸部伤及合并伤伤情特点、并发症发生率等进行回顾性对比分析。结果　重症胸外伤以男性青壮年多见 ,交通事故伤为其最常见原因 ,较其它致伤原因更易引起颅脑和腹部脏器损伤 (P <0 .0 1 ) ;胸部穿透性锐器伤一般合并血气胸 ,且休克发生率以及肺挫伤、浮动胸壁发生率较高。结论　应对不同致伤原因引起的重症胸外伤分别进行重点救治     

闭合性心脏损伤的诊断和治疗(附28例报告)

目的 总结闭合性心脏损伤的诊治经验。方法 回顾1978年1月－1997年12月收治的28例各类闭合闭性心脏损伤的病历资料,对其损伤类型、临床表现及治疗进行分析。结果 本组27例治愈,1例死亡,死亡率3．6％。结论 正确诊断、并根据不同类型的损伤进行及时合理的治疗,大多数伤员预后良好。     

Role of chest CT scan in atypical cardiac trauma management: Left ventricle injury by a nail gun

We report a case of an accidental penetrating cardiac trauma with a nail gun. A 28-year-old man was repairing a sofa with a nail gun when a nail was misfired to his chest. At the time of his presentation, he underwent chest CT scan, showing the nail as a sharp hyperdense foreign body penetrating the chest wall passing through the lower lobe of the left lung and finally the anterior aspect of left ventricle cavity. This report highlights the utility of the chest CT scan to detect trajectory of the misfired nail accurately and instantaneously in a hemodynamically stable patient to assist in the surgery plan.     

钝性胸部伤早期救治中64排螺旋CT的应用

目的探讨64排螺旋CT在钝性胸部伤早期救治中的作用。方法回顾性分析2006年1月以来收治的170例钝性胸部伤，单纯胸部伤74例，多发伤96例，胸部伤AIS2—4分，平均3．2分；多发伤ISS11～34分，平均24．6分。其中到院后3小时内64排螺旋CT检查160例，平均8分钟。结果诊断肺挫伤117例，肺挫裂伤及肺内血肿19例，肺不张24例，血胸67例，气胸45例，血气胸52例，纵隔血肿7例，纵隔积气8例，皮下气肿25例，膈疝17例，肋骨骨折103例，连枷胸34例。143例（84．1％）经非手术处理，其中43例行胸腔闭式引流术，22例行机械呼吸支持。紧急剖胸手术27例（15．9％）。治愈161例，死亡9例（5．3％）。结论胸部钝性伤初次评价在有条件时应首选采用64排螺旋CT扫描。     

Acute tamponade after blunt chest trauma

We report a case of high-impact blunt chest trauma resulting in bilateral lung contusion and rupture of the right atrial appendage with subsequent hemopericardium leading to acute right heart failure. Although tamponade remains a clinical diagnosis, in this case CT findings confirmed the diagnosis, initially unsuspected, which led to successful therapeutic intervention. We believe that in patients with high-velocity trauma and possible blunt injury to the chest, a cardiac injury should always be searched for and excluded.     

投射物钝挫伤的研究进展

钝挫伤是生活中尤其是交通事故中常见的伤类之一。非致命性武器击中人体或子弹击中防弹衣可造成钝挫伤,其造成的损伤效应与通常交通事故钝挫伤有所不同,对投射物钝挫伤的研究可以了解人体组织对投射物撞击的力学响应,确定人体损伤与投射物载荷之间的量效关系。本文就当前投射物造成钝挫伤的致伤机制、研究现状和评估标准进行综述。     

钝性胸部伤早期救治中64排螺旋CT的应用

目的 探讨64排螺旋CT在钝性胸部伤早期救治中的作用.方法 回顾性分析2006年1月以来收治的170例钝性胸部伤,单纯胸部伤74例,多发伤96例,胸部伤AIS 2～4分,平均3.2分;多发伤 ISS 11～34分,平均24.6分.其中到院后3小时内64排螺旋CT检查160例,平均8分钟.结果 诊断肺挫伤117例,肺挫裂伤及肺内血肿19例,肺不张24例,血胸67例,气胸45例,血气胸52例,纵隔血肿7例,纵隔积气8例,皮下气肿25例,膈疝17例,肋骨骨折103 例,连枷胸34例.143例(84.1%)经非手术处理,其中43例行胸腔闭式引流术,22例行机械呼吸支持.紧急剖胸手术27例(15.9%).治愈161例,死亡9例(5.3%).结论 胸部钝性伤初次评价在有条件时应首选采用64排螺旋CT扫描.     

Imaging of blunt chest trauma

In western European countries most blunt chest traumas are associated with motor vehicle and sport-related accidents. In Switzerland, 39 of 10,000 inhabitants were involved and severely injured in road accidents in 1998. Fifty two percent of them suffered from blunt chest trauma. According to the Swiss Federal Office of Statistics, traumas represented in men the fourth major cause of death (4 %) after cardiovascular disease (38 %), cancer (28 %), and respiratory disease (7 %) in 1998. The outcome of chest trauma patients is determined mainly by the severity of the lesions, the prompt appropriate treatment delivered on the scene of the accident, the time needed to transport the patient to a trauma center, and the immediate recognition of the lesions by a trained emergency team. Other determining factors include age as well as coexisting cardiac, pulmonary, and renal diseases. Our purpose was to review the wide spectrum of pathologies related to blunt chest trauma involving the chest wall, pleura, lungs, trachea and bronchi, aorta, aortic arch vessels, and diaphragm. A particular focus on the diagnostic impact of CT is demonstrated. Received: 29 November 1999; Accepted: 28 January 2000