5例心脏刀刺伤的急救分析

目的评价分析心脏刀刺伤后急救与临床效果。方法5例心脏刀刺伤就诊后由急诊室直接送到手术室,经左胸前外侧切口手术,切开心包,清除积血及血凝块,解除心包压塞,修补心脏创口。结果5例心脏刀刺伤病人除1例进入急诊室时呼吸、心跳停止而死亡外,其余4例均治愈出院。结论心脏外伤切忌反复费时检查,以免延误治疗时机。伤后快速诊断、有效的心肺复苏、紧急剖胸心包腔减压和心脏修补是挽救患者生命的最有效治疗措施。     

救治心脏刀穿透伤的体会

５例心脏穿透伤病人，３例急症剖胸行心脏修补术获救，２例由于失去手术机会死亡获救３例的为刀刺伤，２例为右室前壁，１例工室前壁。心脏伤口分别为２ｃｍ、０．８ｃｍ、２ｃｍ大小。均穿透心肌全层达心这内。死亡的１例是经左胸枪弹穿透左右心室，１例为由左胸刀穿透右讣和主动脉。     

胸部刀刺伤剖胸探查的指征和手术策略

目的探讨胸部刀刺伤剖胸探查的指征和手术策略。 方法回顾性分析上海交通大学附属第六人民医院胸外科2006年1月至2017年12月经剖胸探查救治的80例胸部刀刺伤患者的临床资料。 结果80例胸部刀刺伤患者中单纯胸部刀刺伤36例，合并腹部损伤16例，合并四肢损伤21例，颈根部损伤7例；平均损伤严重度评分(ISS)16.42分。所有患者行急诊剖胸探查术，治愈76例(95%)，死亡4例(5%)，死亡原因为心脏破裂、失血性休克、弥散性血管性凝血(DIC)。 结论进行性的血气胸、通气障碍、心脏压塞是急诊剖胸探查的重要指征，合理把握手术指征、选择手术路径是救治胸部刀刺伤的关键。     

心脏刀刺伤17例报告

目的：总结心脏刀刺伤的诊断及抢救经验。方法：对1988年至2002年期间抢救心脏刀刺伤的临床资料进行总结，分析术前、术中、术后一些问题的处理。结果：我们认为心脏刀刺伤抢救成功的关键在于积极争取手术时间，减少不必要的检查环节，一旦怀疑心脏穿透性损伤，应即刻行剖胸探查术。     

心脏刀刺伤43例抢救分析

心脏刀刺伤４３例抢救分析邹志田，徐健，朱晓峰我院１９７４年１月至１９９４年８月共收治心脏刀刺伤４３例，现报道如下。１临床资料全组男３７例，女６例。年龄１１～５７岁。伤后０～４小时被送至急诊室。入院时左胸前壁有伤口者３８例，左胸后壁有伤口者１例，右胸前...     

心脏刀刺伤15例

198 6年 9月～ 2 0 0 0年 12月 ,我院收治心脏刀刺伤患者 15例 ,经抗休克、解除心脏压塞、修补心脏裂口和处理合并伤等治疗 ,获得满意效果。1　临床资料与方法本组共 15例 ,男 14例 ,女 1例。年龄 14～ 4 2岁。均为刀刺伤 ,右前胸 3例 ,左前胸 12例。胸壁伤口长 1.0～ 5 .0 cm,     

心脏破裂伤的急救

目的总结心脏破裂伤的急救体会。方法38例心脏破裂伤病人,平均年龄（32．5±10．5）岁。心脏刀刺伤35例,心脏挤压伤2例,鱼叉刺伤1例,均急诊行开胸探查术,修补心脏裂口,同时处理合并损伤。术中回输自体血800～6000 ml。结果术中、术后共死亡3例。1例术后神志障碍,高压氧治疗2周,术后1年恢复正常;1例心脏贯通伤病人,先行ERT修补心脏左、右室裂伤,1个月后行外伤性室间隔缺损介入封堵,顺利出院;3例术后心包积液者经处理后痊愈;其余病人恢复良好,心功能Ⅰ级。结论紧急剖胸解除心脏压塞、修补心脏伤口、控制出血是心脏破裂伤救治成功的关键。     

穿通性心脏损伤三例报告

我院自1982年以来共收治3例心脏穿通伤,均经紧急剖胸手术,确诊后缝合修补,并已治愈,现报道如下。例1 男,23岁。于1987年12月7日被尖刀刺伤左侧胸部,流血量多,曾昏迷。来院时有心包填塞和失血性休克症状,左侧胸壁腋后线第7肋间处有一新鲜的2cm创口。诊断:心包填塞,心脏损伤。立即输液、输血、抗休克,同时于气管静脉复合麻醉下行紧急剖胸手术,经创口左前外侧切口入胸,心包切开后有多量鲜血伴以凝血块涌出,发现左心室近心尖处有0.8cm伤口,鲜血外涌,此时突然心脏停搏,血压下降为零,以指轻压创口迅速以细丝线缝合3针,行心脏按摩并快速加压输血等,约4分钟后心脏逐渐复跳,34天后出院,一年后随访已恢复工作。例2.男,14岁。于1984年4月13日,以尖刀刺伤左     

经腹心脏刀刺伤的诊断与治疗

目的　探讨和总结经腹心脏刀刺伤的诊断与治疗方法。方法　回顾性分析 5例经腹心脏刀刺伤的临床资料。结果　全组病例均以腹部刀刺伤收治腹部外科 ,3例为右心室穿透伤 ,其中 1例伴有心包填塞 ,1例为临床隐匿型 ;2例左心室穿透伤。全组均急诊手术治愈。结论　腹部外科医生应熟悉心脏穿透伤的诊断和治疗 ,对经腹心脏刀刺伤迅速诊断及有效处理是提高治愈率的重要因素     

108例刃器膈肌伤临床诊治体会

目的总结108例刃器膈肌伤诊治体会。方法回顾分析108例刃器膈肌伤病例,平均年龄28.1岁。尖锐刀刺伤96例,刀砍伤12例;96例位于胸肋部,12例位于上腹部。均急诊行剖胸术,修补膈肌裂口,同时处理合并损伤脏器。结果术中、术后共死亡4例：3例心脏、多脏器破裂,大出血死亡;1例食管破裂感染死亡,其余均救活。结论早期诊断,尽快手术治疗,妥善处理合并之多脏器损伤是刃器膈肌伤救治成功的关键。     

Clinical aspects of cardiac stab wounds: report of 20 cases

Penetrating cardiac wounds are the most dramatic injuries which need a rapid diagnosis and surgical intervention. This clinical pathology has a high increasing incidence in the whole world. We aimed to present our personal experience in such cases. The study was carried out along a period of 31 years. From 1974 to 2004, 20 patients (mean age, 34 years; 17 male) with penetrating cardiac stab wounds were treated. The initial clinical presentation was cardiac tamponade ("blue injured"-8 patients, 40%), hemorrhagic shock ("white injured"-3 patients, 15%), both being implied with 8 patients (40%), one of the aspects being predominant. One patient was stabile. All patients were immediately transferred to the operating room. The left ventricle was found to be the most frequent site of injury (7 patients, 35%), followed by right atrium (6 patients, 30%), right ventricle (4 patients, 20%), left atrium (1 patient, 5%) and both ventricles (1 patient, 5%). There were 17 (85%) penetrating cardiac wounds, 2(10%) penetrant stab injuries and one (5%) non-penetrant cardiac wound. Cardiorrhaphy was performed in all cases. The postoperative complication was pneumonia in 2 cases. In the present study, the survival rate was significantly high (80%). In conclusion, these promising results suggest that a wound with a severe prognosis may be turned into a relative trauma, harmless for the patients who will survive until surgical admission.     

Pericardial tamponade: a critical determinant for survival following penetrating cardiac wounds

Previous studies have emphasized injury mechanism, wound site, and presenting vital signs as critical determinants for survival following penetrating cardiac injury. Our experience suggests pericardial tamponade is another crucial factor and is the basis for this study. Prognostic features were reviewed in 100 consecutive, unselected patients with acute cardiac injuries. Mechanism was stab wound in 57, and gunshot injury in 43. Location included right ventricle in 55, left ventricle in 49, right atrium in 16, and left atrium in seven. Overall salvage was 31%,; 27 (47%) of 57 stab wounds, four (9%) of 43 gunshot wounds, 22 (49%) of 45 right, and nine (23%) of 39 left heart wounds. The presence or absence of pericardial tamponade was documented in 77 patients. Patients with tamponade had a survival of 73% (24/33) compared to 11% (5/44) in those without its protective effect. The presence of tamponade improved survival (p less than 0.05) following stab injuries (77% vs. 29%), gunshot wounds (57% vs. none), right heart wounds (79% vs. 28%), left heart injuries (71% vs. 12%), and overall in patients arriving with vital signs (96% vs. 50%). Multivariant discriminant analysis by logistic regression demonstrated cardiac tamponade was a critical independent factor in patient survival, and suggested that it may be more influential than presenting vital signs in determining outcome.     

Successful surgical management of penetrating cardiac injury

A 60-year-old Asian man who suffered penetrating thoracoabdominal injuries was admitted to our hospital in a state of shock. Because the results of a chest computed tomogram (CT) strongly suggested a left ventricular injury, an emergency thoracotomy was performed. A laceration of the left ventricle (3 cm) was sutured and was closed without cardiopulmonary bypass, and coexisting lacerations of the superior mesenteric artery (SMA) and small bowel were surgically repaired. During the procedure, cardiac arrest occurred, but the patient recovered without any apparent neurologic deficit. Postoperative examinations using echocardiogram, CT, and cardiac catheterization revealed a delayed rupture of the left ventricle. On the 28th day after surgery, he was transferred to another hospital for elective cardiac surgery. Primary management of penetrating cardiac injury is discussed in this report.     

Pericardial drainage prior to operation contributes to surgical repair of traumatic cardiac injury

We report on two cases of successful surgical repair of cardiac injury: one involving a left ventricular stab injury and the other a blunt rupture of the right atrium. Each patient underwent emergency surgical repair, the former via left anterolateral thoracotomy and the latter via median sternotomy, following pericardial drainage tube insertion from the subxiphoid area. The operative approach was chosen according to the color of drained blood, i.e., arterial bleeding indicated left anterolateral thoracotomy, while venous bleeding indicated median sternotomy. We conclude that pericardial drainage via the subxiphoid approach prior to induction of anesthesia is an easy and useful technique to perform, not only to release cardiac tamponade but to determine the operative approach in patients suffering from cardiac tamponade following cardiac injury.     

Pericardial drainage prior to operation contributes to surgical repair of traumatic cardiac injury.

We report on two cases of successful surgical repair of cardiac injury: one involving a left ventricular stab injury and the other a blunt rupture of the right atrium. Each patient underwent emergency surgical repair, the former via left anterolateral thoracotomy and the latter via median sternotomy, following pericardial drainage tube insertion from the subxiphoid area. The operative approach was chosen according to the color of drained blood, i.e., arterial bleeding indicated left anterolateral thoracotomy, while venous bleeding indicated median sternotomy. We conclude that pericardial drainage via the subxiphoid approach prior to induction of anesthesia is an easy and useful technique to perform, not only to release cardiac tamponade but to determine the operative approach in patients suffering from cardiac tamponade following cardiac injury.     

Blunt traumatic cardiac rupture: Therapeutic options and outcomes

Introduction

Cardiac rupture following blunt thoracic trauma is rarely encountered by clinicians, since it commonly causes death at the scene. With advances in traumatology, blunt cardiac rupture had been increasingly disclosed in various ways. This study reviews our experience of patients with suspected blunt traumatic cardiac rupture and proposes treatment protocols for the same.

Methods

This is a 5-year retrospective study of trauma patients confirmed with blunt traumatic cardiac rupture admitted to a university-affiliated tertiary trauma referral centre. The following information was collected from the patients: age, sex, mechanism of injury, initial effective diagnostic tool used for diagnosing blunt cardiac rupture, location and size of the cardiac injury, associated injury and injury severity score (ISS), reversed trauma score (RTS), survival probability of trauma and injury severity scoring (TRISS), vital signs and biochemical lab data on arrival at the trauma centre, time elapsed from injury to diagnosis and surgery, surgical details, hospital course and final outcome.

Results

The study comprised 8 men and 3 women with a median age of 39 years (range: 24-73 years) and the median follow-up was 5.5 months (range: 1-35 months). The ISS, RTS, and TRISS scores of the patients were 32.18 ± 5.7 (range: 25-43), 6.267 ± 1.684 (range: 2.628-7.841), and 72.4 ± 25.6% (range: 28.6-95.5%), respectively. Cardiac injuries were first detected using focused assessment with sonography for trauma (FAST) in 4 (36.3%) patients, using transthoracic echocardiography in 3 (27.3%) patients, chest CT in 1 (9%) patient, and intra-operatively in 3 (27.3%) patients. The sites of cardiac injury comprised the superior vena cava/right atrium junction (n = 4), right atrial auricle (n = 1), right ventricle (n = 4), left ventricular contusion (n = 1), and diffuse endomyocardial dissection over the right and left ventricles (n = 1). Notably, 2 had pericardial lacerations presenting as a massive haemothorax, which initially masked the cardiac rupture. The in-hospital mortality was 27.3% (3/11) with 1 intra-operative death, 1 multiple organ failure, and 1 death while waiting for cardiac transplantation. Another patient with morbid neurological defects died on the thirty-third postoperative day; the overall survival was 63.6% (7/11). Compared with the surviving patients, the fatalities had higher RTS and TRISS scores, serum creatinine levels, had received greater blood transfusions, and had a worse preoperative conscious state.

Conclusions

We proposed a protocol combining various diagnostic tools, including FAST, CT, transthoracic echocardiography, and TEE, to manage suspected blunt traumatic cardiac rupture. Pericardial defects can mask the cardiac lesion and complicate definite cardiac repair. Comorbid trauma, particularly neurological injury, may have an impact on the survival of such patients, despite timely repair of the cardiac lesions.     

Surgical management of penetrating cardiac injuries using a fibrin glue sheet

A penetrating cardiac injury is among the most lethal of all injuries. We present a case of penetrating cardiac injuries to both ventricles. A laceration on the right ventricle was repaired using buttressed sutures, while an injury to the left ventricle was repaired using a collagen mesh dressing covered by fibrin glue (TachoComb patch) without employing cardiopulmonary bypass. The patient recovered uneventfully without a ventricular pseudoaneurysm. Our results demonstrate the usefulness of a TachoComb patch for penetrating cardiac injuries occurring adjacent to the large coronary artery in the posterior wall of the heart.     

Blunt traumatic cardiac rupture. A 5-year experience.

Blunt traumatic cardiac rupture is associated with a high rate of mortality. A review of the computerized trauma registry (1983 to 1988) identified 32 patients with this injury (ages 19 to 65 years; mean age, 39.5 years; 21 men and 11 women). Twenty-one patients (65.6%) were injured in vehicular crashes, 3 (9.4%) in pedestrian accidents, 3 (9.4%) in motorcycle accidents; 3 (9.4%) sustained crush injury; 1 (3.1%) was injured by a fall; and 1 (3.1%) was kicked in the chest by a horse. Anatomic injuries included right atrial rupture (13[40.6%]), left atrial rupture (8 [25%]), right ventricular rupture (10[31.3%]), left ventricular rupture (4[12.5%]), and rupture of two cardiac chambers (3 [9.4%]). Diagnosis was made by thoracotomy in all 20 patients presenting in cardiac arrest. In the remaining 12 patients, the diagnosis was established in seven by emergency left anterolateral thoracotomy and in five by subxyphoid pericardial window. Seven of these 12 patients (58.3%) had clinical cardiac tamponade and significant upper torso cyanosis. The mean Injury Severity Score (ISS), Trauma Score (TS), and Glasgow Coma Scale (GCS) score were 33.8, 13.2, and 14.3, respectively, among survivors and 51.5, 8.3, and 7.0 for nonsurvivors. The overall mortality rate was 81.3% (26 of 32 patients), the only survivors being those presenting with vital signs (6 of 12 patients [50%]). All patients with rupture of two cardiac chambers or with ventricular rupture died. The mortality rate from myocardial rupture is very high. Rapid prehospital transportation, a high index of suspicion, and prompt surgical intervention contribute to survival in these patients.     

Cardiac injuries--a clinical and autopsy profile

One hundred two patients sustaining cardiac injuries over a 4-year period were analysed to highlight the natural history of the cardiac injuries. There were 45 blunt, 36 stab, and 21 gunshot injuries. The injury involved the ventricle in 85, atrium in seven, pulmonary artery in five cases, and resulted in crush injury to the heart in the remaining five cases. Thirty-three patients (32.3%) died on the scene and 58 (56.9%) died during the transportation. Only 11 patients (10.8%) reached the hospital alive, and ten of these patients survived following thoracotomy and repair of the cardiac injury. The factors influencing the natural course of cardiac injury were analysed: 2.2% of patients with blunt cardiac trauma reached the hospital alive compared to 19.4% with stab and 14.3% with gunshot injuries; ventricular injuries had a greater prehospital mortality compared to atrial or pulmonary artery injuries; 11.3% of patients sustaining injury to right ventricle reached the hospital alive compared to 3% of those with left ventricular injuries. These data emphasize the need for rapid transport, immediate recognition, and aggressive surgical management, to make a favourable impact on the natural history of cardiac injuries.     

Survival following nonpenetrating traumatic rupture of cardiac chambers

We report the cases of 3 patients who survived cardiac chamber rupture resulting from blunt external trauma. All were drivers in motor vehicle collisions. All were seen with signs of pericardial tamponade and were treated by pericardiocentesis followed by emergency thoracotomy performed in the operating room. Ruptures of the right atrium and right and left ventricles were repaired by manual suture techniques without cardiopulmonary bypass. The cases of 37 previously reported patients who survived this injury are reviewed. We believe that patients with cardiac rupture who reach the hospital alive can often be saved by prompt diagnosis and immediate surgical treatment.