Cardiac injuries caused by trauma: Review and case reports

Assessment of suspected cardiac injuries in a trauma setting is a challenging and time-critical matter, with clinical and imaging findings having complementary roles in the formation of an accurate diagnosis. In this article, we review the supporting literature for the pathophysiology, classification and evaluation of cardiac injuries caused by trauma. We also describe 4 cardiac trauma patients seen at a tertiary referral hospital.     

烫伤后大鼠心肌力学变化及血清心肌肌钙蛋白T在心肌损伤诊断中的应用

目的 :探索烫伤后大鼠心肌舒缩功能变化及心肌肌钙蛋白T(cTnT)在心肌损伤诊断中的应用。方法 :复制大鼠 30 %TBSAⅢ°烫伤动物模型。观察非烫伤对照组及烫伤后 1、3、6、12、2 4、48、72小时左心室力学参数(LVSP、LVEDP、±dp/dtmax)和血清cTnT、CK、LDH含量变化。结果 :(1)动物烫伤后 1小时 -dp/dtmax显著下降 ,LVEDP明显升高 ;LVSP、+dp/dtmax伤后 3小时显著下降 ,均于 12小时变化最大 ,至 72小时变化仍较明显 (P <0 0 1) ;(2 )cTnT于伤后 1小时显著上升 ,12小时比对照值升高 43倍 ,至 72小时仍保持在高水平 ;而LDH、CK分别于伤后 3小时、6小时开始上升 ,至 72小时已接近正常 (P <0 0 5 )。结论 :(1)烫伤后大鼠左心室舒缩功能明显下降 ,且舒张功能障碍的发生早于收缩功能 ;(2 )cTnT是诊断烧伤后心肌损伤的可靠指标。     

白藜芦醇预处理对心肌细胞缺血/再灌注损伤的保护作用

目的观察白藜芦醇预处理对心肌缺血再灌注损伤的保护作用。方法培养乳鼠心肌细胞,模拟I/R损伤,随机分为阴性对照组、缺血再灌组及白藜芦醇预处理组,采用台盼蓝穿透法及MTT比色法测定细胞活力,检测细胞培养液中LDH活性及心肌细胞Na^＋-K^＋-ATP酶、Ca^2＋-ATP酶活力。结果Res预处理可提高心肌细胞活力;稳定心肌细胞膜,抑制LDH释放;保护心肌细胞钠泵和钙泵功能,减轻再灌注损伤。结论白藜芦醇预处理对心肌缺血再灌注损伤有明显保护作用。     

氯沙坦和卡托普利对大白兔心肌缺血再灌注损伤影响的比较

 目的比较氯沙坦和卡托普利对心肌缺血再灌注损伤的影响.方法健康大白兔随机分为2组,每组各10只:(1)对照组:每日灌服卡托普利40 mg/kg;(2)治疗组:每日灌服氯沙坦40 mg/kg,给药7 d.所有大白兔制作心肌缺血再灌注动物模型,观察心律失常的发生率、心率的变化.复灌后120 min采血,测定血清肌酸磷酸激酶(CPK)、乳酸脱氢酶(LDH)、一氧化氮(NO)、一氧化氮合酶(eNOS)、血管紧张素Ⅱ(AngⅡ)、丙二醛(MDA)及超氧化物歧化酶(SOD)的含量.实验完毕,分别用双重染色确定心肌梗死的面积.结果氯沙坦治疗组CPK、LDH和MDA较对照组明显降低(P＜0.05),而NO、eNOS和SOD则明显增高,降低了心肌缺血再灌注诱发室性心律失常的发生率,具有明显的负性频率作用.治疗组梗死心肌占危险区心肌重量百分比(30.21±5.10)%,较对照组(37.67±6.46)%显著降低.结论氯沙坦能明显减轻心肌缺血再灌注损伤.     

参麦注射液对大鼠心肌缺血/再灌注心律失常的影响

目的探讨参麦注射液对大鼠缺血/再灌注心律失常的影响及其作用机制。方法复制大鼠缺血/再灌注模型,采用缺血10min和缺血60min两种模型观察缺血性心律失常,观察发生率最高的缺血10min后再灌注心律失常,对照组和参麦注射液组分别给予生理盐水和参麦注射液1.5ml/kg,动态Ⅱ导心电图监测室性早搏（PVB）、室性心动过速（VT）及心室颤动与扑动（VF）的发生率。结果参麦注射液可明显减少缺血10min和60min心律失常PVB、VT、VF的发生率（P〈0.01）,亦可明显减少再灌注10min心律失常VT（P〈0.05）及VF（P〈0.01）的发生率。结论参麦注射液可明显减少大鼠缺血/再灌注心律失常的发生率。     

烧伤对大鼠心肌组织磷脂酶A2和ATPase活性的影响

烧伤后心脏功能受到明显抑制，其原因可能和心肌细胞器质性损伤有关。采用大鼠烧伤模型，研究３０％Ⅲ度烧伤对大鼠心肌细胞磷脂酶Ａ２和ＡＴＰａｓｅ活性的影响。提示烧伤后心肌存在能量代谢障碍，造成心肌内磷脂酶Ａ２活性升高，进而导致心肌细胞器质性损伤。     

大鼠心肌缺血再灌注损伤中的心肌细胞凋亡

 目的 观察MIRI时心肌细胞凋亡现象及其病理组织学改变,探讨细胞凋亡在MIRI中的意义.方法 采用SD大鼠MIRI模型,用原位末端标记染色检测心肌细胞凋亡和HE染色法检测心肌病理组织学改变.结果 假手术组及MIRI大鼠左室非缺血心肌组织中均末发现凋亡细胞出现,MIRI60 min、90 min和120 min大鼠缺血心肌中均可见凋亡细胞,且凋亡细胞的个数随再灌注时间的延长而增多,分别为36.3±8.76个/视野,38.41±14.21个/视野和48.01±23.87个/视野..结论 缺血后再灌注损伤可诱发心肌细胞凋亡.     

双源双能量CT成像评估猪急性心肌缺血再灌注损伤的实验研究

目的 评价双源双能量CT(DECT)成像诊断猪急性心肌缺血再灌注损伤的可行性和准确性.方法 8只猪通过开胸结扎冠状动脉左前降支(LAD)或第一对角支(D1)建立再灌注损伤模型,术后行DECT心肌灌注成像扫描.检查结束后立即处死动物,取出心脏,进行氯化三苯基四氮唑(TTC)染色,分析心肌缺血再灌注损伤范围.以病理结果为参照,测量损伤区、非损伤区的CT值以及损伤区面积.将左心室壁分为17个节段,确定DECT心肌灌注碘图、DECT(140、100和平均加权120 kV)3组图像和大体病理上心肌损伤的节段数.以病理结果为金标准分别评价DECT心肌灌注碘图、3组图像显示心肌损伤的敏感性、特异性和一致性.利用方差检验分析损伤区和非损伤心肌不同管电压条件的CT值、大体病理和DECT 3组图像所测量损伤区重量的差异.结果 8只猪DECT心肌灌注碘图见心尖前壁、心尖间隔灌注稀疏甚至缺损,DECT 3组图像中再灌注损伤区CT值均较正常心肌明显降低.与病理金标准对照,DECT心肌灌注碘图诊断再灌注损伤的敏感性、特异性分别为85.2％ (23/27)、86.2％ (94/109),Kappa值为0.62;DECT3组图像的敏感性、特异性和Kappa值:140 kV组分别为88.9％ (24/27)、92.7％ (101/109),0.76;100 kV组分别为85.2％ (23/27)、89.0％(97/109),0.67;平均加权120 kV组分别为88.9％ (24/27)、91.7％ (100/109),0.74.DECT 3组图像测量损伤心肌重量与大体病理所测值之间差异无统计学意义(F=0.419,P=0.741).结论 DECT心肌灌注成像可用于检测猪急性心肌缺血再灌注损伤,与病理诊断一致性较好.     

心脏闭合性损伤后晚期并发症和后遗症的诊断与治疗

目的：笔者报告心脏闭合性损伤晚期并发症和后遗症７例，旨在提高临床对这类病变的诊断和治疗水平。方法：本组病例根据外伤史、临床征象并结合胸部Ｘ线和心电图等检查提示了这类晚期病变。本组主要依靠二维超声心动图和彩色多普勒确立诊断。确诊时间为伤后４０～７３０天。结果：全组计有迟发性纤维素性血心包和缩窄性心包炎各１例，均进行了部分心包切除术；室壁瘤合并室间隔穿孔１例，作了室壁瘤切除及室间隔缺损修补术；二尖瓣关闭不全１例，施行了二尖瓣替换术；三尖瓣关闭不全３例，除１例返流小保守治疗外，余２例分别接受了三尖瓣修复术和换瓣术。全组均康复出院。结论：对心脏闭合性损伤都应作长期随访观察；二维超声心动图和彩色多普勒是检出这类病变简单而可靠的手段；这类病变的手术时机、手术方式和方法应根据伤情和病变来决定。     

急性酒精中毒患者心肌生化标记物测定及其临床意义

 目的 探讨急性酒精中毒患者心肌生化标记物的变化及其临床意义.方法 检测80例急性酒精中毒患者心肌生化标记物,并比较分析其心脏事件发生率.同时,选取16名健康者作为常规对照.结果 急性酒精中毒患者心肌生化标记物及心脏事件发生率显著高于健康对照组.结论 急性酒精中毒可引起心肌生化标记物的改变,造成心肌一过性损害.     

舒血宁注射液对大鼠心肌缺血再灌注损伤的保护作用

目的观察舒血宁对大鼠心肌缺血再灌注（MIR）损伤后的保护作用。方法30只SD雄性大鼠随机分成假手术组、手术组和舒血宁组。采用结扎左冠状动脉前降支（LAD）复制大鼠心肌缺血再灌注损伤模型,用氯化三苯四唑（TTC）染色法测定心肌梗死面积,测定血浆肌酸激酶（CK—MB）和肌钙蛋白I（cTnI）浓度水平以及心肌组织NO的含量。结果与手术组相比,舒血宁组心肌梗死面积明显减少,并能显著降低血清CK～MB、cTnI浓度以及提高心肌组织NO的含量。结论舒血宁对心肌缺血再灌注损伤有明显的保护作用,可能与提高心肌NO的含量有关。     

Radiomics of Non-Contrast-Enhanced T1 Mapping: Diagnostic and Predictive Performance for Myocardial Injury in Acute ST-Segment-Elevation Myocardial Infarction

ObjectiveTo evaluate the feasibility of texture analysis on non-contrast-enhanced T1 maps of cardiac magnetic resonance (CMR) imaging for the diagnosis of myocardial injury in acute myocardial infarction (MI).Materials and MethodsThis study included 68 patients (57 males and 11 females; mean age, 55.7 ± 10.5 years) with acute ST-segment-elevation MI who had undergone 3T CMR after a percutaneous coronary intervention. Forty patients of them also underwent a 6-month follow-up CMR. The CMR protocol included T2-weighted imaging, T1 mapping, rest first-pass perfusion, and late gadolinium enhancement. Radiomics features were extracted from the T1 maps using open-source software. Radiomics signatures were constructed with the selected strongest features to evaluate the myocardial injury severity and predict the recovery of left ventricular (LV) longitudinal systolic myocardial contractility.ResultsA total of 1088 segments of the acute CMR images were analyzed; 103 (9.5%) segments showed microvascular obstruction (MVO), and 557 (51.2%) segments showed MI. A total of 640 segments were included in the 6-month follow-up analysis, of which 160 (25.0%) segments showed favorable recovery of LV longitudinal systolic myocardial contractility. Combined radiomics signature and T1 values resulted in a higher diagnostic performance for MVO compared to T1 values alone (area under the curve [AUC] in the training set; 0.88, 0.72, p = 0.031: AUC in the test set; 0.86, 0.71, p002). Combined radiomics signature and T1 values also provided a higher predictive value for LV longitudinal systolic myocardial contractility recovery compared to T1 values (AUC in the training set; 0.76, 0.55, p < 0.001: AUC in the test set; 0.77, 0.60, p < 0.001).ConclusionThe combination of radiomics of non-contrast-enhanced T1 mapping and T1 values could provide higher diagnostic accuracy for MVO. Radiomics also provides incremental value in the prediction of LV longitudinal systolic myocardial contractility at six months.     

实时三维超声心动图在评估心梗患者左心功能的应用价值

目的:本研究以磁共振成像(MRI)检查结果为标准,应用实时三维超声心动图(real time 3-dimensional echocardiography,RT-3DE),定量评价左心室收缩功能,并比较同组病例的二维超声心动(two-dimensionalechocardiograp hy,2D)的心功能指标,探讨实时三维超声心动图在心梗患者心功能评价中的应用价值.方法:临床诊断心梗患者33例,均行心脏MRI、二维超声心动图、实时三维超声心动图.结果:RT-3DE和MRI两种方法的心功能指标差异无统计学意义,收缩末期容积(ESV)、舒张末期容积(EDV)、每搏输出量(SV)、左室射血分数(EF)相关性高(r=0.81～0.87);2D和MRI两种方法测量的心功能指标差异没有统计学意义,EDV、SV相关性较高(r值分别为0.61、0.67);ESV和EF值相关性中等或较低(r值分别为0.41和0.33).结论:RT-3DE能够准确、可靠的定量评价左心功能,用于定量评价心梗患者左心室收缩功能较2D更准确.     

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。     

心脏锐器伤的救治

心脏锐器伤是致命性损伤,随着社会的发展,其发生率有增高的趋势。它属于外科急症,具有死亡率高、需要在事发地医院就地抢救的临床特点。本文复习国内外文献资料,对心脏锐器伤的流行病学特点与变迁、快速诊断的方法、抢救与后续治疗方面及亚临床的前瞻性研究等进行综述。     

大面积严重烧伤患者早期检测血清脂肪酸结合蛋白价值的探讨

目的 :通过检测大面积严重烧伤患者早期血清脂肪酸结合蛋白水平变化 ,探讨其在大面积严重烧伤患者早期发生并发心肌损伤的临床诊治价值。方法 :对 33例大面积严重烧伤患者和 30名健康对照组采血行FABP和肌酸磷酸激酶同功酶 (CK MB)定量检测 ,血清FABP采用双抗体夹心酶联免疫一步法定量检测 ,CK MB采用免疫抑制法。结果 :大面积严重烧伤患者早期FABP、CK MB水平均显著性升高 (P <0 0 1) ;血清FABP的阳性率(81 8% )显著高于血清CK MB的阳性率 (48 5 % )。结论 :大面积严重烧伤患者早期FABP定量测定比CK MB具有更高的敏感性。检测大面积严重烧伤患者早期血清FABP水平 ,与其并发心肌损伤的临床诊治具有重要价值 ,对判定病情及并发心肌损伤具有指导意义     

双参素胶囊对大鼠实验性心肌缺血再灌注损伤的保护作用

 目的 观察双参素胶囊对大鼠实验性心肌缺血再灌注损伤的保护作用.方法 通过在体大鼠结扎左冠状动脉前降支30min,再灌注24 h制备实验性心肌缺血再灌注损伤模型,双参素胶囊按17.5mg/kg、35 mg/kg、70 mg/kg给大鼠连续灌胃7 d,阳性药物组连续灌胃福辛普利20 mg/kg,7 d,假手术组及再灌模型组灌胃0.5%羧甲基纤维素钠,计算心肌梗死范围(MIS),测定血清天冬酸氨基转移酶(AST)等的活性.结果　双参素胶囊可使实验性心肌缺血再灌注损伤大鼠的MIS明显缩小(P＜0.05或P＜0.01),血清AST、LDH、CK-MB活性及MDA含量明显降低(P＜0.05或P＜0.01),血清SOD及GSH-Px活性明显增加(P＜0.05或P＜0.01),亦可使血浆ET和AngⅡ含量明显下降(P＜0.05或P＜0.01).结论 双参素胶囊对大鼠实验性心肌缺血再灌注损伤具有明显保护作用.     

Myocardial injury due to lightning

The report deals with a 27-year-old male who was standing in a tent and was injured by lightning as it struck a tree about 1.5 m away. He immediately lost consciousness and exhibited ventricular fibrillation when the emergency physician arrived. A clinical picture of hypoxaemic brain damage emerged after initially successful resuscitation. Brain death was diagnosed on the fifth day after injury. The discrete external findings (remaining arborescent skin marks) contrasted markedly with the severe thermal damage to the pectoral muscle and cardiac musculature found during the autopsy. The histological cardiac findings indicated severe acute myocardial infarction affecting virtually all parts of the myocardium. Received: 3 February 1997 / Received in revised form: 7 May 1997     

Dipyridamole myocardial SPECT with low heart rate response indicates cardiac autonomic dysfunction in patients with diabetes

BACKGROUND: Because dipyridamole is used to assess heart rate (HR) variability, we investigated whether a low HR response during dipyridamole single photon emission computed tomography (SPECT) in patients with diabetes indicates the presence of cardiac autonomic neuropathy (CAN). METHODS AND RESULTS: Subjects were 61 non-insulin-dependent diabetes patients without perfusion defects, myocardial infarction, or arrhythmia who underwent thallium 201 SPECT imaging. The control group comprised 28 subjects without diabetes. HR was measured during infusion of dipyridamole at a rate of 0.14 mg/kg/min, and peak-baseline ratios of 1.20 or less were defined as low. CAN severity was classified by standard autonomic function tests as severe (n = 22), mild (n = 19), or none (n = 20). HR ratios were significantly attenuated in patients with diabetes compared with those in control subjects (1.22 +/- 0.12 vs 1.32 +/- 0.12, P <.001). Among the patients with diabetes, HR ratios decreased as CAN severity increased from none (1.32 +/- 0.10) to mild (1.23 +/- 0.12, P <.05) to severe (1.13 +/- 0.08, P <.005). There was good correlation between HR ratio and R-R interval ratio to deep breathing and to Valsalva, and patients with low HR ratios showed an attenuated response to both tests (all P <.001). The sensitivity and specificity of HR ratios in the detection of CAN were 77% and 74% for severe CAN and 63% and 90% for mild-to-severe CAN, respectively. CONCLUSIONS: In patients with diabetes who have normal dipyridamole SPECT results, an attenuated HR response observed during stress indicates a high likelihood of CAN. Further work that assesses these results in diabetes patients with coronary artery disease is warranted.     

Myocardial abscess resulting in a pseudoaneurysm: Case report

This report describes the diagnostic workup of a case of a pseudonaneurysm of the heart resulting from Staphylococcal pericarditis and/or abscesses of the myocardium. The percardial effusion and myocardial abscesses were detected on 2D echcardiography and computed tomography. The resulting pseudoaneurysm could be demonstrated on magnetic resonance imaging and color Doppler ultrasound, and confirmed by left ventriculography. Color-encoded Doppler ultrasound alone would have provided the definitive diagnosis of the aneurysm.